Cord occlusion in twin reversed arterial perfusion sequence: a retrospective study of laser photocoagulation vs radiofrequency ablation.

Introduction: Twin reversed arterial perfusion (TRAP) sequence is a rare condition complicating monozygotic multiple gestations. Prenatal management via umbilical cord occlusion (UCO) of the anomalous twin has been shown to improve pump twin survival. We compared outcomes of gestations with high-risk TRAP sequence treated with mid-trimester UCO using laser photocoagulation vs radiofrequency ablation (RFA).

Methods: This is a retrospective, single-center, cohort study of all patients with high-risk TRAP sequence who underwent UCO from 2006-2023. High-risk criteria were defined as follows: larger abdominal circumference of the anomalous twin, polyhydramnios, critically abnormal Doppler waveforms in the pump twin, hydrops in the pump twin, and/or monoamniotic twins. The primary outcome was 30-day survival of the pump twin.

Results: The 74 patients were divided equally between the laser and RFA groups. For the 2 groups, mean gestational age (GA) at UCO (20.5 ± 2.3 vs 20.7 ± 3.1 weeks, P=.987) and mean GA at delivery (35.2 ± 4.6 vs 34.5 ± 5.7 weeks, P=.812) were similar. The 30-day neonatal survival rate did not differ (91.9% [34/37] vs 89.2% [33/37], OR: 1.37 [0.29-6.61], P=.692).

Conclusion: No difference in 30-day neonatal survival was identified in patients with high-risk TRAP sequence who underwent mid-trimester UCO by laser vs RFA.