Fetal Medicine Unit, Division of Developmental Sciences, St George's Hospital Medical School, London, UK.
Ultrasound Obstet Gynecol. 2013 Jul;42(1):6-14. doi: 10.1002/uog.12495.
To ascertain the outcome of twin reversed arterial perfusion (TRAP) sequence cases managed in our unit and to review systematically cases reported in the literature treated with intrafetal laser therapy.
This was a retrospective cohort study of all TRAP sequence cases identified from 2000 to 2012 at our center. Pregnancy management and outcomes were ascertained from maternal and neonatal records. We also performed a meta-analysis of the literature on the use of intrafetal laser therapy for the treatment of TRAP. Adverse pregnancy outcome was defined as a composite of intrauterine death (IUD) and preterm birth before 37 weeks' gestation.
Twenty-three cases of TRAP were identified during the study period. Six were managed conservatively and 17 were treated with laser therapy. All cases managed conservatively were complicated by IUD at a median gestational age of 14 + 4 (interquartile range (IQR), 12 + 4 to 16 + 5) weeks. Among the treated cases, 14 (82%) delivered a healthy twin at a median gestational age of 37 + 1 (IQR, 34 + 0 to 38 + 3) weeks. Ten studies were reviewed in detail and the data were combined with those from the current study. The overall neonatal survival was 80%. Adverse pregnancy outcome was significantly lower when the treatment was performed before 16 weeks' gestation (19 vs 66%, P = 0.0025).
The study data demonstrate a high risk of spontaneous fetal demise in early pregnancy, lack of accurate prognostic markers and improved pregnancy outcome after laser therapy in cases of TRAP. In these cases we recommend elective treatment with intrafetal laser therapy at between 13 and 16 weeks' gestation.
确定本单位管理的双胎反向动脉灌注（TRAP）序列病例的结局，并系统回顾文献中报道的经宫内激光治疗的病例。
这是对本中心 2000 年至 2012 年期间所有 TRAP 序列病例的回顾性队列研究。从产妇和新生儿记录中确定妊娠管理和结局。我们还对宫内激光治疗治疗 TRAP 的文献进行了荟萃分析。不良妊娠结局定义为宫内死亡（IUD）和 37 周前早产的复合。
研究期间共发现 23 例 TRAP。6 例保守治疗，17 例接受激光治疗。所有保守治疗的病例均在 14 周+4（四分位距（IQR），12 周+4 至 16 周+5）周时发生 IUD。在治疗病例中，14 例（82%）在 37 周+1（IQR，34 周+0 至 38 周+3）周时分娩出健康的双胞胎。详细审查了 10 项研究，并将这些数据与当前研究的数据合并。总的新生儿存活率为 80%。治疗在 16 周前进行时，不良妊娠结局明显降低（19%比 66%，P=0.0025）。
研究数据表明，TRAP 早期妊娠自然胎儿死亡风险高，缺乏准确的预后标志物，激光治疗后妊娠结局改善。在这些情况下，我们建议在 13 至 16 周之间选择性进行宫内激光治疗。
