Perinatal outcome of twin reversed arterial perfusion sequence: A single center's experience

Abstract

Objective To report our experience of using radiofrequency ablation (RFA) to treat fetuses diagnosed with twin reversed arterial perfusion (TRAP) sequence and to evaluate the perinatal outcome of pump twins. Methods Twenty-six fetuses diagnosed with the TRAP sequence were retrospectively analyzed between July 1998 and September 2011 at Asan Medical Center. Four were lost to follow-up after diagnosis and, therefore, were excluded from further evaluation. The perinatal outcomes of pump twins were evaluated by reviewing the medical records. Results Twenty-two fetuses were diagnosed with the TRAP sequence during the study period, including 15 monochorionic-diamniotic pregnancies and four monochorionic-monoamniotic pregnancies. Three patients had triplet pregnancies. The median gestational age at diagnosis was 17.4 weeks (range, 11.0 to 27.0 weeks). Of these 22 cases, in utero RFA was performed in 11 (50%), alcohol ablation in one (4.5%) and the remaining 10 (45.5%) underwent conservative management. The median gestational age at in utero intervention was 21.0 weeks (range, 17.6 to 25.0 weeks). The overall neonatal survival rate was 77% (17 of 22). The median gestational age at delivery was 37.3 weeks (range, 30.2 to 40.1 weeks). All of the surviving infants are doing well without any complications. Conclusion For fetuses with the TRAP sequence, proper in utero treatment with RFA enables to continue the pregnancy with a good prognosis.