Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

2021 ◽  
pp. 1-7
Author(s):  
Eva Christin Weber ◽  
Florian Recker ◽  
Ingo Gottschalk ◽  
Brigitte Strizek ◽  
Annegret Geipel ◽  
...  
Keyword(s):  
Expectant Management ◽  
First Trimester ◽  
Bleeding Complications ◽  
Intrauterine Death ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Management Group ◽  
Group A ◽  
Group B ◽  
Twin Reversed Arterial Perfusion

<b><i>Introduction:</i></b> The aim of this study is to evaluate the outcome of pregnancies complicated by monochorionic monoamniotic twin reversed arterial perfusion sequence (MOMA TRAP) diagnosed in the first trimester. <b><i>Methods:</i></b> All patients diagnosed with MOMA TRAP sequence &#x3c;14.0 weeks of gestation in a 10-year study period were retrospectively analyzed for intrauterine course and outcome. All patients were offered either expectant management or intrauterine intervention. Adverse outcome was defined as either intrauterine death (IUD), neonatal death or preterm birth &#x3c;34.0 weeks of gestation. <b><i>Results:</i></b> In the study period, 17 cases with MOMA TRAP sequence were diagnosed. Of these, 2 couples opted for termination of pregnancy. The remaining 15 were divided into 2 groups depending on the management: group A (<i>n</i> = 8) with expectant management and group B (<i>n</i> = 7) with intrauterine intervention. All fetuses in group A died before 20 weeks. Survival in group B was significantly better with 4/7 (57.1%) life births at a median of 39.6 weeks of gestation (<i>p</i> = 0.0256). The reasons for IUD in the 3 cases in group B were hemodynamic, strangulation, and bleeding complications during intervention. <b><i>Conclusions:</i></b> Intrauterine intervention in MOMA TRAP pregnancies significantly improves neonatal survival, although it is still associated with a substantial risk for IUD by hemodynamic complications or entanglement.

Outcome of TRAP Sequence Treated in the First Trimester – A Ten-Year Single-Center Experience

2021 ◽  
Author(s):  
Eva Christin Weber ◽  
Florian Recker ◽  
Ingo Gottschalk ◽  
Brigitte Strizek ◽  
Annegret Geipel ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Adverse Outcome ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Death ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Single Center Experience ◽  
Group A ◽  
Group B

Abstract Purpose To evaluate the outcome of first trimester intervention by intrafetal laser (IFL) in pregnancies complicated by twin reversed arterial perfusion (TRAP). Materials and Methods For a 10-year study period, all patients with TRAP diagnosed < 14.0 weeks of gestation were retrospectively analyzed for intrauterine course and outcome. Monoamniotic pregnancies were excluded. Patients were offered either intervention by IFL in the first trimester, expectant management, or termination of pregnancy (TOP). Adverse outcome was defined as either intrauterine death (IUD), neonatal death, or preterm birth. Results In 45 cases TRAP was diagnosed. 17 monoamniotics were excluded. The cohort was divided into two groups according to management. Group A: 24 cases underwent IFL and group B: 4 cases were managed expectantly. No patient opted for TOP. In group A, 70.8 % of pump twins were born alive, including one preterm delivery, and 29.2 % died within four days after the intervention. All 4 expectantly managed cases in group B had an adverse outcome (1 preterm delivery, 3 IUDs < 15.0 weeks). There were no neonatal deaths. In cases treated by IFL, a comparison of survivors and non-survivors identified no significant differences in gestational age at IFL or any of the assessed biometrical and functional parameters. There was a trend towards better outcome in the second half of the study period. Conclusion IFL in first trimester TRAP sequence is technically feasible but is associated with significant mortality, albeit less than previously reported. No risk stratification is possible using the investigated parameters. However, there seems to be a learning curve.

scholarly journals Ultrasound Assessment of Twin Reversed Arterial Perfusion Sequence for the Prediction of Adverse Pregnancy Outcomes in the First Trimester

2021 ◽  
Author(s):  
Ying Tang ◽  
Yan Zeng ◽  
Taizhu Yang ◽  
Pan Yang ◽  
Shan Bao ◽  
...  
Keyword(s):  
Gestational Age ◽  
Pregnancy Outcomes ◽  
First Trimester ◽  
Adverse Pregnancy Outcomes ◽  
University Hospital ◽  
Intrauterine Death ◽  
Crown Rump Length ◽  
Arterial Perfusion ◽  
Adverse Pregnancy ◽  
Twin Reversed Arterial Perfusion

Abstract ObjectivesTo investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14 weeks. MethodsPregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin’s crown-rump length (CRL) and acardiac twin’s upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL-URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. ResultsTwenty-one pregnant women aged 21–39 years with a gestation of 11-14 weeks were recruited. TRAP was diagnosed on average (± standard deviation [SD]) at pregnancy week 13.1 ± 0.18. The pump twins’ mean (± SD) CRL was 6.65 ± 1.1 cm. The incidence of intrauterine death for the pump twins was 19.0% (n=4), the miscarriage rate was 14.3% (n=3), and the live birth rate was 66.7% (n=14). The (CRL-URL)/CRL ratios between the non-survival (intrauterine death and miscarriage) and survival groups significantly differed (0.33 ± 0.08 vs. 0.58 ± 0.08, p < 0.05). Similarly, the URL/CRL ratios between the non-survival and survival groups significantly differed (0.67 ± 0.08 vs. 0.42 ± 0.08, p < 0.05). ConclusionsThe (CRL-URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.

Intrafetal Laser Coagulation for Trap Sequence in a Complicated Dichorionic Triamniotic Triplet Pregnancy Case Report and Review of the Literature

2017 ◽  
Vol 10 (2) ◽  
pp. 146-150
Author(s):  
Petya P. Chaveeva ◽  
Slavcho T. Tomov ◽  
Atanas D. Shterev
Keyword(s):  
Pregnancy Outcome ◽  
Color Doppler ◽  
First Trimester ◽  
Laser Coagulation ◽  
Triplet Pregnancy ◽  
Vitro Fertilization ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion

Summary A rare case is reported of twin-reversed arterial perfusion (TRAP) sequence in a triplet pregnancy, fetal intervention in the first trimester and pregnancy outcome. We report a case of TRAP sequence complication in dichorionic triamniotic triplet pregnancy, with a normally developing fetus and an acardiac fetus connected via arterio-arterial anastomoses in a monochorionic diamniotic twin pair and a separate fetus. TRAP sequence was diagnosed at 13 weeks in triplet pregnancy after in vitro fertilization (IVF) and embryo transfer of two blastocysts. Color Doppler assessment showed persistent arterial flow in the acardiac twin. Intrafetal laser coagulation was carried out at the time of the diagnosis, and the pregnancy outcome was two survivals at 36.4 weeks of gestation.

Prenatal surgery in a triplet pregnancy complicated by a double twin reversed arterial perfusion (TRAP) sequence

2012 ◽  
Vol 1 (1-2) ◽  
Author(s):  
Maria-Elisabeth Smet ◽  
Dirk Smet ◽  
Philip DeKoninck ◽  
Luc De Catte ◽  
Jan Deprest ◽  
...  
Keyword(s):  
Normal Growth ◽  
First Trimester ◽  
Baby Girl ◽  
Triplet Pregnancy ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
First Case ◽  
Umbilical Cords ◽  
Twin Reversed Arterial Perfusion ◽  
Double Twin

AbstractTo the best of our knowledge, we report the first case of a successful antenatal intervention in a double twin reversed arterial perfusion (TRAP) sequence in a monoamniotic monochorial triplet pregnancy. After diagnosis during first-trimester ultrasound, fetoscopic coagulation and transection of the umbilical cords of both acardiac members was performed at 16 weeks of gestation. The immediate postoperative course was complicated with iatrogenic preterm premature rupture of membranes, which was successfully reversed with an amniopatch procedure. Consequent sonographic assessments showed a healthy fetus with normal growth and development, together with progressive atrophy of the acardiac fetuses. Owing to placental abruption, an urgent cesarean section was performed at 32 weeks. A baby girl of 1600 g was born in good general condition. Except for the butts of the transected umbilical cords, there were no remnants of the TRAP twins to be distinguished. After a neonatal follow up of 64 days, the baby girl could be discharged.

scholarly journals A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

2019 ◽  
Vol 8 (5) ◽  
pp. 1889
Author(s):  
Anjuman Alam ◽  
Poonam Choubey
Keyword(s):  
Gestational Hypertension ◽  
Severe Hypertension ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Expectant Management ◽  
Pulmonary Complications ◽  
Induction Of Labour ◽  
Management Group ◽  
Group A ◽  
Group B

Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.

MINIMALLY INVASIVE MANAGEMENT OF TWIN REVERSED ARTERIAL PERFUSION SEQUENCE (TRAP)

2006 ◽  
Vol 17 (1) ◽  
pp. 1-22 ◽  
Author(s):  
NJ SEBIRE ◽  
AE WONG ◽  
W SEPULVEDA
Keyword(s):  
Rare Complication ◽  
Intrauterine Death ◽  
Apparent Lack ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Arterial Blood ◽  
Underlying Pathophysiology ◽  
Invasive Management ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Acardiac anomaly, twin reversed arterial perfusion (TRAP) sequence or chorioangopagus parasiticus are synonymous terms referring to a rare complication unique to monochorionic multiple pregnancies in which there is apparent lack of a well-formed cardiac structure in one fetus (the acardiac twin), which is abnormally perfused by a structurally normal co-twin (the pump twin) through a single superficial artery-to-artery placental anastomosis. The condition therefore results in arterial blood flowing in a retrograde fashion from the pump twin towards the affected fetus, and this underlying pathophysiology indicates the preferred use of the clinical term TRAP-sequence. Pathophysiologically, the acardiac fetus acts as a parasite that can only survive in-utero as it is haemodynamically dependent upon the pump twin. The principal perinatal problems being associated with the TRAP sequence are pump-twin congestive heart failure, polyhydramnios and severe preterm delivery, although intrauterine death of the pump twin has been reported even in the absence of such features.

scholarly journals A COMPARITIVE STUDY ON INDUCTION OF LABOUR VERSUS EXPECTANT MANAGEMENT IN TERM PREMATURE RUPTURE OF MEMBRANES IN TERTIARY CARE HOSPITAL ,VISAKHAPATNAM

2019 ◽  
pp. 1-3
Author(s):  
Kavitha Gayak
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Care Hospital ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Management Group ◽  
Group A ◽  
Group B

Premature rupture of membranes (PROM), also called Prelabour Rupture Of Membranes, is classically dened as rupture of membranes before labour and accounts for 0.8-0.9% of all pregnancies at term. this study was conducted over a period of 14 months ( from March 2018 to May 2019) in a tertiary care medical college . A total of 100 term PROM patients were recruited in our study – and divided into two groups randomly--50 (Group A) patients were managed conservatively and 50 (Group- B) patients underwent induction of labour. Both these patient groups were studied to compare the feto-maternal outcome. Group-A (conservative management group) patients were observed to await the spontaneous onset of labour pains for at least 24 hours. Patients in group B were induced with either - PGE1 tab (misoprostol) 25 µgm 4 hourly orally or iv oxytocin infusion. the PROM-delivery interval was < 12 hours in 72 % of induced groups (Group B) and 10% (5) in group- A (conservative or expectant group). LSCS rate was 10 % in group-A (expectant group) & 15 % in group –B (induced group). Sepsis rate, maternal and fetal, hospital stay, NICU admission & duration of NICU stay were notably higher in group – A (expectant management group). therefore, from our study we concluded that immediate induction of labour in term PROM cases shortens the PROM- delivery interval, hospital stay, NICU stay and reduction in both maternal & neonatal sepsis

COMPARATIVE STUDY OF MATERNALAND NEONATAL OUTCOME OF ELECTIVE INDUCTION OF LABOUR VS EXPECTANT MANAGEMENT AT 40- 40+6 WEEKS OF GESTATION

2021 ◽  
pp. 37-39
Author(s):  
Indrani Mandal ◽  
Bivash Mondal ◽  
Debarshi Jana
Keyword(s):  
Vaginal Delivery ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Instrumental Delivery ◽  
Special Care Unit ◽  
Management Group ◽  
Elective Induction ◽  
Group A ◽  
Group B

OBJECTIVES: To compare and analyse in each group- delivery complications like postpartum haemorrhage, obstetric anal sphincter injury at 40-40+6 Week of Gestation. To compare and analyse in each group- perinatal outcomes, mainly perinatal mortality and special care unit admission. METHODS: This prospective comparative observational study was conducted in the Department of Gynaecology & Obstetrics, R. G. Kar Medical College and Hospital. For my study I had taken a total of 276 mothers whom I had subdivided into 2 groups. Group Ahad 138 mothers who had induction of labour (I) by some method. Remaining 138 mothers were allocated to Group B who had only watchful expectancy with monitoring and labeed as expectant management group(EM). RESULT: In group-A (I), 5(3.6%) patients had instrumental delivery in comparison to group B(EM) which had 15(10.9%) of instrumental delivery. LSCS was also higher in group B i.e 36(26.1%) as compared to group A i.e 25(18.1%). 108(78.3%) mothers had vaginal delivery who were induced whereas 87(63.0%) had vaginal delivery in expectant management group. Therefore, induction group had better outcome in terms of mode of delivery.It was also statistically signicant (p=0.0098). The distribution on the basis of APGAR score at 5 minutes of babies in between two groups was signicant. CONCLUSION: Elective induction at 40+ weeks is associated with a lower rate of caesarean delivery and does not increase the risk of major complications for newborns and can be offered to mothers having low risk and crossed their expected date of delivery.The ACOG says elective induction at 40+ weeks is a reasonable option for healthy women. Induction of labour at 40+ weeks should not be routine for women but it is important to counsel them and let them decide whether they want to be induced and when.

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