Perinatal Management for Monochorionic Twin Reversed Arterial Perfusion Sequence

Objective To evaluate the perinatal managementof monochorionic twin pregnancies complicated by twin reversed arterial perfusion(TRAP) sequence. Methods A retrospectively study was performed on the management and perinatal outcome of monochorionic multiple pregnanciescomplicated by TRAP sequence at West China Second University Hospital from May 2010 to May 2014. Results Thirteen cases of TRAP sequence were identified during the study period，included 4 monochorionicmonoamniotic (MCMA) twins, 7 monochorionic diamniotic(MCDA) twins,1 monochorionic-triamniotic (MCTA) triplet pregnancy and 1 MCDA triplet pregnancy. Gestational age at diagnosis of TRAP sequence was from 11⁺⁵ to 31⁺⁶ gestational weeks in 12 cases. TRAP sequence was diagnosed by post-mortem examination in the case of MCDA triplet pregnancy transferred to our hospital with inevitable abortion at 21⁺³ weeks.9 cases underwent conservative management.In the conservative management group,intrauterine death of the pump twin occurred in two MCMA twins and 7 cases delivered a healthy pump twin between 31⁺³ and 39⁺⁵ weeks of gestation. 2 cases were treated with bipolar cord coagulation of acardiac twin and delivered a healthy pump twin at 32⁺¹ and 33⁺⁵ weeks of gestation. Conclusion Early antenatal diagnosis of TRAP sequence is very important. Consultation with the parents is recommended as to the options of conservative management or intervention. Conservative management with close monitoring may be a safe option for TRAP sequence with a small acardiac twin. Bipolar cord coagulation of acardiac twin is a relatively safe and effective procedure in TRAP sequence with indications to intervention.