Gynecology & Obstetrics
Open Access

Abstract

Early Radiofrequency Ablation for Twin Reversed Arterial Perfusion TRAP) Sequence: Case Report and Literature Review

Kara Aitken, James Andrews, Tim Van Mieghem, Rory Windrim, John Kachura and Greg Ryan

Background: High output cardiac failure resulting in fetal death or severe prematurity is a common complication of twin reversed arterial perfusion (TRAP) sequence. Various minimally invasive prenatal interventions have been proposed to improve outcomes for the pump fetus. Uncertainty still exists regarding the optimal timing of these interventions. Early intervention may protect the pump twin against prematurity from complications of cardiac failure or unexpected fetal death, although it carries a risk of procedure related pregnancy loss. Expectant management with surveillance and performing an intervention later in gestation if necessary’ would potentially avoid some procedures but does not protect against unexpected fetal death.

Case: A healthy 30 year-old woman, gravida 2 para 1, was diagnosed with TRAP sequence at 13+1 weeks gestation. An uncomplicated ultrasound guided Radiofrequency Ablation (RFA) procedure ablating the vessels in the parasitic mass was performed at 15+0 weeks. The remainder of the pregnancy was uneventful and resulted in a term vaginal delivery of a healthy infant.

Conclusion: Based on our current knowledge of TRAP sequence and current instrumentation for fetal surgery, early occlusion of the vessels perfusing an acardiac fetus appears feasible and safe. Randomized trials on timing of intervention are urgently needed.