Radiofrequency Ablation of Umbilical Cord for Reduction of Twin Reversed Arterial Perfusion Sequence: A Case Series and a Literature Review

Document Type : Review Article

Authors

1 Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran Maternal, Fetal, and Neonatal Research Centre, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Twin reversed arterial perfusion (TRAP) sequence is a rare disorder of monochorionic twins in which the placental anastomoses results in transitioning the blood from the normal fetus to the acardiac twin by a reversed arterial flow. This study aimed to investigate the radiofrequency ablation (RFA) outcome of the umbilical cord occlusion of acardiac twin to reduce TRAP sequence in monochorionic diamniotic pregnancies.
Methods: This prospective study investigated 25 cases of monochorionic diamniotic twin pregnancy with one acardiac fetus and selective reduction by RFA in the second trimester of gestational age in a referral hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran, from 2018 to 2019.
Results: The mean±SD of gestational age in RFA and delivery were 20.0±3.8 and 35w±6.0 days, respectively, with a survival rate of 84%. A total of nine neonates were admitted to the neonatal intensive care unit, and four miscarriages were recorded in less than 24 weeks. The RFA procedure was successful in all pregnancies for selective termination of the acardiac twin.
Conclusion: RFA was a safe and reasonable method in a selective-fetal reduction in acardiac twins for monochorionic pregnancies.
 
 

Keywords

References

  1. Cabassa P, Fichera A, Prefumo F, Taddei F, Gandolfi S, Maroldi R, Frusca T, et al. The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature. Eur J Obstet Gynecol. 2013;166(2):127-132.
  2. Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol. 1990;163(3):907-1.
  3. Khanduri S, Chhabra S, Raja A,Bhagat S. Twin reversed arterial perfusion sequence: a rare entity. J Clin Imaging Sci. 2015;5:9.
  4. Pepe F, Cristina Teodoro M, Luca C, Privitera F. Conservative management in a case of uncomplicated trap sequence: a case report and brief literature review. J Prenat Med. 2015;9(3-4):29.
  5. Wong AE, Sepulveda W. Acardiac anomaly: current issues in prenatal assessment and treatment. Prenat Diagn: Published in Affiliation With the International Society for Prenatal Diagnosis. 2005;25(9):796-806.
  6. Rossi AC, D'Addario V. Umbilical cord occlusion for selective feticide in complicated monochorionic twins: a systematic review of literature. Am J Obstet Gynecol. 2009;200(2):123-9.
  7. Rahimi Sharbaf F, Haghiri M, Shirazi M, Golshahi F, Arabipoor A, Zolfaghari Z, Niromanesh SH. Contributing factors of fetal death following radiofrequency ablation in complicated mono-chorionic multiple pregnancies. Int J Pediatr. 2019.
  8. Rahimi-Sharbaf F, Ghaemi M, Nassr AA, Shamshirsaz AA, Shirazi M, et al. Radiofrequency ablation for selective fetal reduction in complicated Monochorionic twins; comparing the outcomes according to the indications. BMC Pregnancy Childbirth. 2021;21(1):189.
  9. Oliver ER, Coleman BG, Goff DA, Horii SC, Howell LJ, RychikJ, Bebbington MW Johnson MP, et al. Twin reversed arterial perfusion sequence: a new method of parabiotic twin mass estimation correlated with pump twin compromise. J Ultrasound Med. 2013;32(12):2115-23.
  10. Wang HM, Li HY, Wang XT, Wang YY, Li L, Liang B, Wang J, Song J, et al. Radiofrequency ablation for selective reduction in complex monochorionic multiple pregnancies: A case series. Taiwan J Obstet Gynecol. 2017;56(6):740-744.
  11. Gallot D, Laurichesse H, Lemery D.Selective feticide in monochorionic twin pregnancies by ultrasound-guided umbilical cord occlusion. Ultrasound Obstet Gynecol. 2003;22(5):484-8.
  12. Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J, et al. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol. 2006;28(5):688-91.
  13. Lanna MM, Rustico MA, Dell'Avanzo M, Schena V, Faiola S, Consonni D, Righini A, Scelsa B, Ferrazzi EM, et al. Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center. Ultrasound Obstet Gynecol. 2012; 39(4):
    407-13.
  14. Kumar S, Paramasivam G, Zhang E, Jones B, Noori M, Prior T, Vasudeva A, Wimalasundera RC, et al. Perinatal- and procedure-related outcomes following radiofrequency ablation in monochorionic pregnancy. Am J Obstet Gynecol. 2014;210(5):454 e1-6.
  15. Gaerty K, Greer RM, Kumar S. Systematic review
    and metaanalysis of perinatal outcomes after radiofrequency ablation and bipolar cord occlusion in monochorionic pregnancies. Am J Obstet Gynecol. 2015;213(5):637-43.
  16. Bebbington MW, Danzer E, Moldenhauer J, Khalek N, Johnson MP. Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies. Ultrasound Obstet Gynecol. 2012;40(3):319-24.
  17. Zhang ZT, Yang T, Liu CX, Li N,et al. Treatment of
    twin reversed arterial perfusion sequence with radiofrequency ablation and expectant management: A single center study in China. Eur J Obstet Gynecol Reprod Biol. 2018;225:9-12.
Iranian Journal of Neonatology
Volume 13, Issue 1
January 2022
Pages 62-66

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