Treatment of twin reversed arterial perfusion sequence with radiofrequency ablation and expectant management: A single center study in China

Objective: To evaluate the treatment of pregnancies in different stages complicated by TRAP sequence at a single medical center in China. Study design: A retrospective study evaluating 25 pregnancies with TRAP sequence was performed at Shengjing Hospital in Shenyang, Liaoning between 2012 and 2016. Patients were diagnosed by ultrasound and categorized into three groups (Ia, Ila and Ilb) and were expectantly managed or performed RFA (radiofrequency ablation) according to their stage of TRAP sequence. Perinatal outcomes and survival rates were analyzed. Results: There were four cases in stage la, 19 cases in stage Ila, and two cases in stage Ilb. Cases in stage la were expectantly managed. Among cases in stage Ila, we performed RFA (radiofrequency ablation) in 10 cases and expectant management in 6 cases, with the remainder of the patients refusing intrauterine treatment. We applied RFA to treat one case in stage Ilb and the other was managed expectantly. For expectant management group and the RFA group, the survival rates were both 64%(7/11). All pump twins in stage Ia survived and the average gestational age at delivery was 37.9 weeks. In stage Ha, the overall survival rate of the pump twin was 70% (7/10) and the average gestational age at delivery was 35.8 weeks in cases treated by RFA. The survival rate was 50% (3/6) and the average gestational age at delivery was 32.8 weeks in expectantly managed cases in stage Ila. No pump twin survived in stage Ha without treatment (3 cases refused any therapy who were excluded) or in stage Ilb. Conclusion: Expectant management is effective for treatment of TRAP sequence in stage Ia. In stage Ila, RFA improves the prognosis of pump twins. (C) 2018 Elsevier B.V. All rights reserved.