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[Interstitial laser coagulation in Twin Reversed Arterial Perfusion sequence]
Piotr Wegrzyn1, Dariusz Borowski, Elzbieta Nowacka
1I Katedra i Kinika Połoznictwa i Ginekologii Warszawskiego Uniwersytetu Medycznego, Polska. piotr.wegrzyn@wum.edu.pl
Ginekologia Polska
|February 6, 2013
Summary
Twin Reversed Arterial Perfusion (TRAP) sequence, a rare pregnancy complication, involves an acardiac twin receiving reversed blood flow from a healthy co-twin. This case highlights successful ultrasound-guided laser coagulation to stop blood flow to the acardiac twin, improving outcomes.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Reproductive Medicine
Background:
- Twin Reversed Arterial Perfusion (TRAP) sequence affects approximately 1% of monochorionic twin pregnancies.
- It involves a non-viable acardiac twin receiving blood supply from a healthy 'pump' co-twin, leading to potential compromise of the pump twin.
- Diagnosis typically occurs in the first trimester, necessitating timely intervention.
Observation:
- A case of monochorionic, diamniotic twin pregnancy complicated by TRAP sequence is presented, diagnosed at 11 weeks gestation.
- An unusual finding included a residual heart in the acardiac twin.
- The pump twin exhibited signs of hemodynamic compromise, including reversed A-wave in the ductus venosus, while the acardiac twin showed subcutaneous edema.
Findings:
- Successful interstitial ultrasound-guided laser coagulation was performed at 16 weeks gestation to occlude the acardiac twin's pelvic vessels and umbilical cord.
- The procedure involved precise targeting with a 17G needle and laser fiber, confirmed by Doppler ultrasound.
- The intervention was uneventful, leading to spontaneous delivery at 33 weeks with a healthy neonate, despite minor postnatal complications.
Implications:
- Interstitial laser coagulation is a less invasive and effective treatment option for TRAP sequence compared to fetoscopic umbilical cord procedures.
- This minimally invasive approach offers a promising method for improving outcomes in complicated twin pregnancies.
- Further randomized studies are warranted to definitively compare treatment modalities, but interstitial laser coagulation appears to be the method of choice at 16 weeks gestation.
