American Journal of Obstetrics & Gynecology
Volume 197, Issue 4 , Pages 399.e1-399.e3, October 2007

Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single-center experience

Presented at the at the 27th Annual Clinical Meeting of the Society for Maternal–Fetal Medicine, San Francisco, CA, Feb. 5-10, 2007.

  • Jeffrey C. Livingston, MD

      Affiliations

    • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH
    • Corresponding Author InformationReprints: Jeffrey Livingston, MD, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0526
    • ,
  • Foong-Yen Lim, MD

      Affiliations

    • Department of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
    • ,
  • William Polzin, MD

      Affiliations

    • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Fetal Care Center of Cincinnati, Cincinnati, OH.
    • ,
  • Jennifer Mason, RN

      Affiliations

    • Department of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
    • ,
  • Timothy M. Crombleholme, MD

      Affiliations

    • Department of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Received 13 March 2007; received in revised form 12 June 2007; accepted 30 July 2007.

Objective

The objective of the study was to review perinatal outcomes in pregnancies treated with intrafetal radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence.

Study Design

Perinatal outcome data from a quaternary care referral center were abstracted from a chart review of pregnancies with TRAP sequence treated in the midtrimester with umbilical cord RFA of the perfused twin.

Results

Twenty-one pregnancies with TRAP sequence were evaluated. Two women had a pump twin demise prior to therapy, 1 with trisomy 21 declined treatment. Four of 20 were treated successfully with RFA but remain undelivered, and 1 was treated with fetoscopic cord coagulation. Twelve of 13 pump twins treated with RFA (94%) survived to 30 days of life. Mean preoperative cardiac combined cardiac output was 588 mL/kg and pump/twin ratio was 0.7 (range 0.4 to 1.1). The effect of RFA on postoperative cardiac output was variable (6-85%). The average gestational age at birth was 37 weeks (range 26-39 weeks).

Conclusion

Primary therapy with RFA is a successful modality for pregnancies complicated by TRAP sequence.

Key words: radiofrequency ablation, twin reversed arterial perfusion, twin reversed arterial perfusion sequence

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 Cite this article as: Livingston JC, Lim F-Y, Polzin W, et al. Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single-center experience. Am J Obstet Gynecol 2007;197:399.e1-399.e3.

PII: S0002-9378(07)00934-9

doi:10.1016/j.ajog.2007.07.051

American Journal of Obstetrics & Gynecology
Volume 197, Issue 4 , Pages 399.e1-399.e3, October 2007

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