Key result
First-trimester intrafetal laser ablation for TRAP sequence is linked to ~42% pump twin mortality.
Why the study?
Does intrafetal laser ablation in the first trimester improve pregnancy outcomes in pregnancies complicated by TRAP sequence?
Observational (n=12)
No
Does intrafetal laser ablation in the first trimester improve pregnancy outcomes in pregnancies complicated by TRAP sequence?
First-trimester intrafetal laser ablation for TRAP sequence has a high fetal loss rate, which appears associated with a large TRAP twin size relative to the pump twin.
High pump twin loss after first-trimester intrafetal laser for TRAP warrants caution; leaves open whether CRL ratio selection improves survival.
Objective: To evaluate the outcome of first trimester intervention (12 +0 to 13 +6 weeks of gestation) in pregnancies complicated by TRAP sequence. Methods: From 2010 onwards, all patients diagnosed with monochorionic diamniotic TRAP sequence undergoing intrafetal laser ablation (IFL) prior to 14 +0 weeks of gestation at the University of Bonn were retrospectively analysed for intrauterine course and pregnancy outcome. Results: In the study period twelve patients were treated by IFL. The mean gestational age at intervention was 13.1 ± 0.5 weeks (range 12 +4 – 13 +6 ). In all cases one intervention sufficed to disrupt the perfusion of the TRAP twin. No case of abortion, preterm premature rupture of membranes (PPROM) or haemorrhage occurred. In five pregnancies (41.7%) daily follow up scans demonstrated intrauterine death of the pump twin at a mean of 67.2 ± 20.0 hours (range 48 – 96) after intervention. The remaining 7 pregnancies continued uneventfully with birth of a healthy infant at term. A comparison of survivors and non-survivors identified a significant difference in the median discordance between the crown-rump length (CRL) of the pump twin and the upper pole-rump length (URL) of the TRAP twin (0.56 vs. 0.36; p < 0.05). A CRL-URL/CRL ratio > 0.48 identified all 7 survivors (p < 0.05). All other assessed parameters were not significantly different. Conclusion: Although technically feasible, IFL in TRAP sequence performed in the first trimester has a significant fetal loss rate. A large TRAP twins size and a small pump twins size seems to be associated with an unfavourable outcome of IFL.
No takes yet. Share an insight, caveat, or question.
Roethlisberger et al. (2016) conducted an observational in Monochorionic diamniotic TRAP sequence (n=12). Intrafetal laser ablation (IFL) was evaluated on Intrauterine death of the pump twin. Intrafetal laser ablation for TRAP sequence in the first trimester resulted in a 41.7% rate of pump twin intrauterine death, with survival associated with a CRL-URL/CRL ratio > 0.48 (p < 0.05).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: