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KMID : 0358420120550080552
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Korean Journal of Obstetrics and Gynecology
2012 Volume.55 No. 8 p.552 ~ p.558
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Perinatal outcome of twin reversed arterial perfusion sequence: A single center’s experience
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Lee Mi-Young
Won Hye-Sung
Lee Kyung-A
Kyeong Kyu-Sang
Jeon Eun-Jin
Shim Jae-Yoon
Lee Pil-Ryang
Kim Ahm
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Abstract
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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.
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KEYWORD
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Twin reversed arterial perfusion sequence, Acardiac twin, Radiofrequency ablation, Fetal therapy.
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