American Journal of Obstetrics & Gynecology
Volume 203, Issue 3 , Pages 213.e1-213.e4, September 2010

The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester

  • Liesbeth Lewi, MD, PhD

      Affiliations

    • Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
    • Division of Woman, Department of Woman and Child, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Catalina Valencia, MD

      Affiliations

    • Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
    • ,
  • Esperanza Gonzalez, MD

      Affiliations

    • Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
    • ,
  • Jan Deprest, MD, PhD

      Affiliations

    • Division of Woman, Department of Woman and Child, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Kypros H. Nicolaides, MD

      Affiliations

    • Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK

Received 29 November 2009; received in revised form 19 February 2010; accepted 12 April 2010. published online 04 June 2010.

Objective

The aim of this study was to document the mortality of twin reversed arterial perfusion (TRAP) sequence from the first trimester to planned intervention at 16-18 weeks.

Study Design

A retrospective review was performed of the outcome of monochorionic twin pregnancies diagnosed with twin reversed arterial perfusion sequence in the first trimester.

Results

Twenty-six pregnancies were diagnosed with twin reversed arterial perfusion sequence in the first trimester: 2 opted for termination of pregnancy and 24 opted for prophylactic intervention to arrest the reversed flow, which was planned at 16-18 weeks. In 8 of 24 (33%) pregnancies, spontaneous death of the pump twin occurred between diagnosis and planned intervention. In 5 of 24 (21%), there was a spontaneous arrest of flow; whereas, in 11 (46%) there was persistent flow toward the acardiac twin at 16-18 weeks.

Conclusion

Twin reversed arterial perfusion carries a high mortality between the first and early second trimester.

Key words: acardiac, monochorionic twin pregnancy, TRAP, twin reversed arterial perfusion

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 This study was supported by a grant from the Fetal Medicine Foundation (Charity no. 1037116).

 Reprints not available from the authors.

 Cite this article as: Lewi L, Valencia C, Gonzalez E, et al. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am J Obstet Gynecol 2010;203:213.e1-4.

PII: S0002-9378(10)00431-X

doi:10.1016/j.ajog.2010.04.018

American Journal of Obstetrics & Gynecology
Volume 203, Issue 3 , Pages 213.e1-213.e4, September 2010

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