Twin reversed arterial perfusion sequence; coagulation of the umbilical cord
A report on the first case in Uruguay
Keywords:
ACARDIAC TWIN, TWIN PREGNANCY, MONOCHORIONIC TWINS, REVERSE ARTERIAL PERFUSION SEQUENCE, TRAP SEQUENCE
Abstract
Twin reversed arterial perfusion sequence (TRAPS) is rather an unusual and severe complication of monochorionic twin pregnancies. It usually occurs when the normal-appearance heart of a twin acts as a pump for one or more dysmorphic twins whose head, thoracic organs and upper limbs fail to totally develop or do not develop at all and thus, have no cardiac activity. The abnormal vascular architecture at the placenta changes the arterial flow towards the acardiac twin. The exact pathophysiological mechanisms that result in this devastating phenomenon are still unknown. The study presents the clinical case of a 19-year- old patient pregnant with monoamniotic, monochorionic twins and a diagnosis of TRAPS, treated by laser coagulation of the acardiac twin’s umbilical cord.
References
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11) Jolly M, Taylor M, Rose G, Govender L, Fisk NM. Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy. BJOG 2001; 108(10):1098-102.
12) Tan TY, Sepulveda W. Acardiac twin: a systematic review of minimally invasive treatment modalities. Ultrasound Obstet Gynecol 2003; 22(4):409-19.
13) Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006; 28(5):688-91.
14) Livingston JC, Lim FY, Polzin W, Mason J, Crombleholme TM. Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single] center experience. Am J Obstet Gynecol 2007; 197(4):399.e1-3.
15) Pagani G, D’Antonio F, Khalil A, Papageorghiou A, Bhide A, Thilaganathan B. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis. Ultrasound Obstet Gynecol 2013; 42:6-14.
16) Jolly M, Taylor M, Rose G, Govender L, Fisk NM. Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy. BJOG 2001; 108(10):1098-102.
2) Benirschke K, Kaufmann P, Baergen R. Multiple pregnancy. En: Benirschke K, Kaufmann P, Baergen R. Pathology of the human placenta. 2nd ed. New York, NY: Springer, 1995:702-10.
3) Steffensen TS, Gilbert-Barness E, Spellacy W, Quintero RA. Placental pathology in trap sequence: clinical and pathogenetic implications. Fetal Pediatr Pathol 2008; 27(1):13-29.
4) Deprest J, Gratacós E. Embarazos monocoriales (II): gemelos discordantes. Indicaciones y técnicas de oclusión de cordón umbilical. En: Gratacós E, Gómez R, Nicolaides K, Romero R, Cabero L. Medicina Fetal. Madrid: Médica Panamericana, 2007:703-8.
5) Chalouhi GE, Stirnemann JJ, Salomon LJ, Essaoui M, Quibel T, Ville Y. Specific complications of monochorionic twin pregnancies: twin-twin transfusion syndrome and twin reversed arterial perfusion sequence. Sem Fetal Neonatal Med 2010; 15(6):349-56.
6) Hecher K, Lewi L, Gratacos E, Huber E, Ville Y, Deprest J. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006; 28:688-91.
7) Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990; 163:907-12.
8) Lewi L, Valencia C, Gonzalez E, Deprest J, Nicolaides KH. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am J Obstet Gynecol 2010; 203:213.e1-4.
9) Sepúlveda WH, Quiroz VH, Giuliano A, Henríquez R. Prenatal ultrasonographic diagnosis of acardiac twin. J Perinat Med 1993; 21(3):241-6.
10) van Gemert MJ, Umur A, van den Wijngaard JP, VanBavel E, Vandenbussche FP, Nikkels PG. Increasing cardiac output and decreasing oxygenation sequence in pump twins of acardiac twin pregnancies. Phys Med Biol 2005; 50(3):N33-42.
11) Jolly M, Taylor M, Rose G, Govender L, Fisk NM. Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy. BJOG 2001; 108(10):1098-102.
12) Tan TY, Sepulveda W. Acardiac twin: a systematic review of minimally invasive treatment modalities. Ultrasound Obstet Gynecol 2003; 22(4):409-19.
13) Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006; 28(5):688-91.
14) Livingston JC, Lim FY, Polzin W, Mason J, Crombleholme TM. Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single] center experience. Am J Obstet Gynecol 2007; 197(4):399.e1-3.
15) Pagani G, D’Antonio F, Khalil A, Papageorghiou A, Bhide A, Thilaganathan B. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis. Ultrasound Obstet Gynecol 2013; 42:6-14.
16) Jolly M, Taylor M, Rose G, Govender L, Fisk NM. Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy. BJOG 2001; 108(10):1098-102.
Published
2021-08-24
How to Cite
1.
Bottaro S, Pérez Penco JM, Bianchi A, Migues A, Putti P, Lapizaga P. Twin reversed arterial perfusion sequence; coagulation of the umbilical cord. Rev. Méd. Urug. [Internet]. 2021Aug.24 [cited 2024Dec.18];37(3):e37314. Available from: https://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/745
Section
Clinical Cases
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