Cord Occlusion in Twin Reversed Arterial Perfusion Sequence: A Retrospective Study of Laser Photocoagulation versus Radiofrequency Ablation
Year: 2024
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Twin reversed arterial perfusion (TRAP) sequence is a rare condition complicating monozygotic multiple gestations. Prenatal management via umbilical cord occlusion (UCO) of the anomalous twin has been shown to improve pump twin survival. We compared outcomes of gestations with high-risk TRAP sequence treated with mid-trimester UCO using laser photocoagulation versus radiofrequency ablation (RFA). METHODS: This is a retrospective, single-center, cohort study of all patients with high-risk TRAP sequence who underwent UCO from 2006-2023. High-risk criteria were defined as follows: larger abdominal circumference of the anomalous twin, polyhydramnios, critically abnormal Doppler waveforms in the pump twin, hydrops in the pump twin, and/or monoamniotic twins. The primary outcome was 30-day survival of the pump twin. RESULTS: The 74 patients were divided equally between the laser and RFA groups. For the 2 groups, mean gestational age (GA) at UCO (20.5 ± 2.3 vs. 20.7 ± 3.1 weeks, p = 0.987) and mean GA at delivery (35.2 ± 4.6 vs. 34.5 ± 5.7 weeks, p = 0.812) were similar. The 30-day neonatal survival rate did not differ (91.9% [34/37] vs. 89.2% [33/37], OR: 1.37 [0.29-6.61], p = 0.692). CONCLUSION: No difference in 30-day neonatal survival was identified in patients with high-risk TRAP sequence who underwent mid-trimester UCO by laser versus RFA.
Source: Fetal Diagnosis and Therapy
DOI: 10.1159/000542494
Authors: Emi J. Komatsu, Catherine Hamzeh, Grace Hamadeh, Arlyn Llanes, Lisa M. Korst, Ramen H. Chmait
Institutions: University of Southern California, University of Balamand
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4404124241