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Twin Reversed Arterial Perfusion Sequence: Current Treatment Options

Authors Vitucci A, Fichera A, Fratelli N, Sartori E, Prefumo F

Received 12 November 2019

Accepted for publication 14 May 2020

Published 28 May 2020 Volume 2020:12 Pages 435—443

DOI https://doi.org/10.2147/IJWH.S214254

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 6

Editor who approved publication: Professor Everett F. Magann


Annachiara Vitucci, Anna Fichera, Nicola Fratelli, Enrico Sartori, Federico Prefumo

Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

Correspondence: Federico Prefumo
Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy
Tel +39 030 3995340
Fax +39 030 3995034
Email federico.prefumo@unibs.it

Abstract: Twin reversed arterial perfusion (TRAP) sequence is a specific and severe complication of monochorionic multiple pregnancy, characterized by vascular anastomosis and partial or complete lack of cardiac development in one twin. Despite its rarity, interest in the international literature is rising, and we aimed to review its pathogenesis, prenatal diagnostic features and treatment options. Due to the parasitic hemodynamic dependence of the acardiac twin on the pump twin, the management of these pregnancies aims to maximize the pump twin’s chances of survival. If treatment is needed, the best timing of intervention is still debated, although the latest studies encourage intervention in the first trimester of pregnancy. As for the technique of choice to interrupt the vascular supply to the acardiac twin, ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels are usually the preferred approaches.

Keywords: TRAP sequence, acardiac twin, pump twin, clinical management, fetal therapy

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