Journal Mobile Options
Table of Contents
Vol. 27, No. 3, 2010
Issue release date: April 2010

Perinatal Outcome of Conservative Management versus Fetal Intervention for Twin Reversed Arterial Perfusion Sequence with a Small Acardiac Twin

Jelin E. · Hirose S. · Rand L. · Curran P. · Feldstein V. · Guevara-Gallardo S. · Jelin A. · Gonzales K. · Goldstein R. · Lee H.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Objective: To examine the outcomes of patients with twin reversed arterial perfusion (TRAP) sequence in which the acardiac twin was ≤50% the weight of the pump twin. Methods: This was a retrospective study conducted with institutional review board approval. The records of all patients referred to UCSF for suspected diagnosis of TRAP between 1994 and 2009 were reviewed (n = 76). Patients with pregnancies complicated by TRAP with an acardiac twin ≤50% the weight of the pump twin were included (21 patients). Exclusion criteria were loss to follow-up (1 patient) and syndromic abnormalities in the pump twin (2 patients). Results: Of the 18 patients with viable pregnancies that met the criteria for analysis, 7 (39%) underwent radiofrequency ablation (RFA) of the acardiac twin and 11 (61%) underwent conservative management. None of the pump twins in either group had hydrops fetalis. Three of the 11 acardiac twins in the conservative management group did not undergo RFA because they did not have blood flow at presentation to UCSF. Survival to delivery was 100% (7/7) in the RFA group and 91% (10/11) in the conservative management group. When we eliminated from our analysis the 3 pregnancies in the conservative management group without blood flow to the acardiac twin, survival to delivery was 88% (7/8). The single death occurred in 1 of the 3 monochorionic-monoamniotic pregnancies in the conservative management group, all of whom had blood flow to the acardiac twin. There were no statistically significant differences in gestational age at delivery, birth weight or survival between the RFA and conservative management groups, even after stratification by blood flow. Conclusions: Conservative management with close monitoring appears to be a safe option for TRAP pregnancies in which the acardiac twin is ≤50% the weight of the pump twin.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Sepulveda W, Sfeir D, Reyes M, Martinez J: Severe polyhydramnios in twin reversed arterial perfusion sequence: successful management with intrafetal alcohol ablation of acardiac twin and amniodrainage. Ultrasound Obstet Gynecol 2000;16:260–263.
  2. Napolitani FD, Schreiber I: The acardiac monster. A review of the world literature and presentation of 2 cases. Am J Obstet Gynecol 1960;80:582–589.
  3. James WH: A note on the epidemiology of acardiac monsters. Teratology 1977;16:211–216.
  4. Moore TR, Gale S, Benirschke K: Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990;163:907–912.
  5. Lee H, Wagner AJ, Sy E, Ball R, Feldstein VA, Goldstein RB, Farmer DL: Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. Am J Obstet Gynecol 2007;196:459, e451–e454.

    External Resources

  6. Golombeck K, Ball RH, Lee H, Farrell JA, Farmer DL, Jacobs VR, Rosen MA, Filly RA, Harrison MR: Maternal morbidity after maternal-fetal surgery. Am J Obstet Gynecol 2006;194:834–839.
  7. Weisz B, Peltz R, Chayen B, Oren M, Zalel Y, Achiron R, Lipitz S: Tailored management of twin reversed arterial perfusion (TRAP) sequence. Ultrasound Obstet Gynecol 2004;23:451–455.
  8. Cordero L, Franco A, Joy SD: Monochorionic monoamniotic twins: neonatal outcome. J Perinatol 2006;26:170–175.
  9. Santema JG, Bourdrez P, Wallenburg HC: Maternal and perinatal complications in triplet compared with twin pregnancy. Eur J Obstet Gynecol Reprod Biol 1995;60:143–147.


Pay-per-View Options
Direct payment This item at the regular price: USD 33.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 23.00