Twin Reversed Arterial Perfusion Sequence: Current Treatment Options.

Area of Science:

• Maternal-Fetal Medicine
• Perinatology
• Reproductive Medicine

Background:

• Twin reversed arterial perfusion (TRAP) sequence is a rare but severe complication of monochorionic multiple pregnancies.
• It involves vascular connections between twins, leading to abnormal development in one (acardiac twin).

Purpose of the Study:

• To review the pathogenesis, prenatal diagnosis, and management of TRAP sequence.
• To discuss current treatment options and optimal timing for intervention.

Main Methods:

• Literature review of pathogenesis, diagnosis, and treatment of TRAP sequence.
• Analysis of current therapeutic approaches including laser ablation and radiofrequency ablation.

Main Results:

• Management focuses on preserving the 'pump twin' by interrupting abnormal blood flow to the acardiac twin.
• Intervention in the first trimester is increasingly favored, though timing remains debated.
• Ultrasound-guided laser coagulation and radiofrequency ablation are preferred treatment modalities.

Conclusions:

• TRAP sequence requires careful prenatal diagnosis and timely management.
• Interventional strategies aim to improve pump twin survival rates.
• Ongoing research is refining optimal treatment timing and techniques.