Single-Center Experiences for Fetal Intervention in Pregnancy Complicated by Twin Reversed Arterial Perfusion Sequence: Case Reports.

Abstract

Objective: We present three cases of fetal intervention in twin reversed arterial perfusion (TRAP) sequence.

Case reports: Case 1. A 22-year-old pregnant woman, 23-week gestational age (WGA), with TRAP sequence. The patient underwent interstitial laser coagulation, in which we successfully coagulated one vessel with direct flow to the acardiac twin's heart but failed to coagulate the vessels to the acardiac twin's pelvis. After the procedure, the patient developed preterm premature rupture of membrane (PPROM) and delivery ensues. The pump twin's weight was 458 g and passed away after two hours.Case 2. A 18-year-old pregnant woman, 25 WGA, with TRAP sequence. This patient underwent bipolar cord coagulation, and we successfully coagulated 3 segments of the cord and finished with amniopatch. Three weeks later, the patient developed preterm premature rupture of membrane and delivery ensues. The pump twin's weight was 1300 g, and she survived after admission in the neonatal intensive care unit (NICU) for 3 months.Case 3. A 23-year-old pregnant woman, 24 WGA, with TRAP sequences. This patient underwent bipolar cord coagulation, and we successfully coagulated 5 segments of the cord. After the pregnancy reaches 37 weeks, we perform an elective cesarean section to deliver the surviving male pump twin baby, who weighs 3100 g.

Conclusion: We reported three cases of TRAP sequences with different treatments and outcomes.