Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single-center experience
Jeffrey C Livingston1, Foong-Yen Lim, William Polzin
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH 45267-0526, USA. livingjc@ucmail.uc.edu
Objective:
The objective of the study was to review perinatal outcomes in pregnancies treated with intrafetal radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence.
Study Design:
Perinatal outcome data from a quaternary care referral center were abstracted from a chart review of pregnancies with TRAP sequence treated in the midtrimester with umbilical cord RFA of the perfused twin.
Results:
Twenty-one pregnancies with TRAP sequence were evaluated. Two women had a pump twin demise prior to therapy, 1 with trisomy 21 declined treatment. Four of 20 were treated successfully with RFA but remain undelivered, and 1 was treated with fetoscopic cord coagulation. Twelve of 13 pump twins treated with RFA (94%) survived to 30 days of life. Mean preoperative cardiac combined cardiac output was 588 mL/kg and pump/twin ratio was 0.7 (range 0.4 to 1.1). The effect of RFA on postoperative cardiac output was variable (6-85%). The average gestational age at birth was 37 weeks (range 26-39 weeks).
Conclusion:
Primary therapy with RFA is a successful modality for pregnancies complicated by TRAP sequence.
