Key result
Ultrasound-guided laser coagulation and radiofrequency ablation are the preferred interventions to interrupt vascular supply to the acardiac twin in TRAP sequence, ideally in the first trimester.
Why the study?
Twin reversed arterial perfusion sequence is a severe complication of monochorionic multiple pregnancy where the optimal timing of interventions remains debated.
Early intervention, particularly in the first trimester using ultrasound-guided laser coagulation or radiofrequency ablation, is recommended to maximize survival of the pump twin in TRAP sequence.
Answers are grounded in this paper and cite their sources.
May support first-trimester laser or RFA in TRAP sequence; leaves open need for prospective validation before practice change.
Twin reversed arterial perfusion sequence, a severe and unique complication of monochorionic multiple pregnancy, is characterized by vascular anastomosis and abnormal or absent cardiac development in the twins. This article reviewed its pathogenesis, prenatal ultrasound diagnosis, and management. The pump twin's chances for survival can be maximized by proper management. The optimal timing of the interventions remains a debate, although the latest studies encourage early intervention, i.e., in the first trimester. The most preferred approach is to interrupt the vascular supply to the acardius, such as through ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels.
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Ye et al. (2022) conducted a review in Twin reversed arterial perfusion (TRAP) sequence. Fetal therapy (laser coagulation, radiofrequency ablation) was evaluated. Ultrasound-guided laser coagulation and radiofrequency ablation are the preferred interventions to interrupt vascular supply to the acardiac twin in TRAP sequence, ideally in the first trimester.
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