Key result
Radiofrequency ablation in two cases of TRAP sequence resulted in the survival of the pump twins, though both pregnancies were complicated by preterm premature rupture of membranes and one neonate suffered brain injury.
Why the study?
Does intrauterine radiofrequency ablation improve outcomes and prevent cardiac failure in pregnancies complicated by twin reversed arterial perfusion sequence?
Case Report (n=2)
No
Does intrauterine radiofrequency ablation improve outcomes and prevent cardiac failure in pregnancies complicated by twin reversed arterial perfusion sequence?
Intrauterine radiofrequency ablation for TRAP sequence can prevent pump twin cardiac failure but carries significant risks of premature rupture of membranes, prematurity, and potential neurologic morbidity.
Adds to sparse data on RFA for TRAP sequence; leaves open the balance of benefits versus complications in larger cohorts.
Twin reversed arterial perfusion (TRAP) sequence occurs in approximately 1% of monozygotic pregnancies. The proposed pathogenesis is the association of paired artery-to-artery and vein-to-vein anastomoses through the placenta combined with delayed cardiac function of one of the embryos early in pregnancy. Presently the most commonly used technique for TRAP sequence is intrauterine radiofrequency ablation (RFA) of the cord of the recipient twin. This report shares the authors' experience in managing similar cases, the rationale leading to clinical decisions, the timing of the RFA procedure, the potential complications associated with TRAP, and the out-come of these two cases.
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Tasha et al. (2017) conducted a case report in Twin reversed arterial perfusion (TRAP) sequence (n=2). Radiofrequency ablation (RFA) was evaluated on Clinical and neonatal outcomes. Radiofrequency ablation in two cases of TRAP sequence resulted in the survival of the pump twins, though both pregnancies were complicated by preterm premature rupture of membranes and one neonate suffered brain injury.
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