[Clinical management and perinatal outcome of twin reversed arterial perfusion sequence in different stage]

To discuss the methods and outcomes of twin reversed arterial perfusion sequence in different stage.

From August 2012 to December 2013, 11 cases were diagnosed with twin reversed arterial perfusion sequence (TRAP) by 3d color Doppler ultrasound in the Maternal ang Fetal Medicine Center, Affiliated Shengjing Hospital, China Medical University, including 3 cases in stage I a, 7 in stage II a and 1 case in stage II b. We performed expected therapy to 3 cases in stage I a and 4 cases in stage II a [1 case (case 9) in stage II a developed to stage II b and was terminated by emergency cesarean section], radio frequency ablation (RFA) selective reduction to 3 cases in stage II a, emergency cesarean section to 1 case in stage II b. All cases except case 1, 4 took cesarean section to terminate pregnancy and would be followed up on the aspect of infant's growth.

(1) 3 cases in stage I a were monitored by sequential ultrasound examination, all donors grew normally, in which 2 acardias arised spontaneous cessation of flow and were implemented of cesarean section after the normal period of gestation; 1 case suffered premature rupture of membrane and experienced the natural childbirth at 34 gestation weeks plus 5 days. The survived average labor weight was 2 923 g. (2) In the 7 stage II a cases, 3 cases were implemented of RFA selective reduction, 2 cases survived and the average labor gestation was 35 weeks plus 1 day and average labor weight was 2 050 g; in 3 expected therapy cases, 1 case suffered premature rupture of membrane at 34 gestation weeks plus 5 days and experienced cesarean section; 1 case was observed for 3 weeks and the donor was stillborn; 1 case progressed to stage II b and experienced cesarean section at 34 gestation weeks plus 5 days; and 1 case was lost of follow up. (3) For 2 cases of stage II b cases, one was progressed from stage II a during expected therapy; the other one had been already in stage II b since visiting and experimented an emergency cesarean section, but the neonate died of heart failure two days after labor. (4) 7 survived neonates were followed up, all had a normal condition compared to kids of the same age, except one suffering a congenital heart disease, patent ductus arteriosus and atrial septal defect and whose weight (6 kg at 7 months) was lighter.

We should make the diagnosis of TRAP as early as soon and choose appropriate therapy according to the stage. According to our research, cases in stage I a can undergo an expected therapy under a sequential ultrasound examination; cases in stage II a can undergo a RFA selective reduction to improve the prognosis of the donor, which can make a good perinatal outcome.