Fisher Katie E, Welsh Alec W, Henry Amanda
School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia.
Department of Maternal-Fetal Medicine Royal Hospital for Women Sydney New South Wales Australia.
Australas J Ultrasound Med. 2016 Sep 26;19(4):133-141. doi: 10.1002/ajum.12024. eCollection 2016 Nov.
Twin reversed arterial perfusion (TRAP) sequence occurs when there is one non-viable twin without cardiac structures and a viable pump twin that perfuses the acardiac mass. This study aims to investigate the management and immediate neonatal outcomes for monochorionic multiple pregnancies complicated by TRAP referred to the NSW Fetal Therapy Centre (NSW FTC).
Retrospective cohort study of multiple pregnancies referred to NSW FTC between April 2006 and April 2014, reviewing data for cases of TRAP sequence (n = 19, including two triplet cases) compared to a timeframe matched sample of uncomplicated monochorionic diamniotic (MCDA) twin pregnancies managed in the unit (n = 45).
Primary management of the 19 TRAP cases was expectant management in 10 (53%), radiofrequency ablation (RFA) in 6 (32%), and bipolar cord coagulation, amniodrainage and termination of pregnancy in 1 case each. 1 of 6 RFA cases had pump twin demise <1 week post-procedure. Average gestation at birth (35.1 ± 5.0 vs. 35.0 ± 2.8 weeks) and mean birthweight (2157 ± 1019 g vs. 2245 ± 537 g) were similar between TRAP pump fetuses and uncomplicated MCDA cases. Pump twin survival was 81% (twins only) compared to 98% for uncomplicated MCDA twins (P = 0.02), and in 5 of 19 (26%) TRAP pregnancies the pump fetus had a congenital anomaly.
Mean gestational age at birth and mean birthweight were similar for both TRAP and uncomplicated MCDA pregnancies. TRAP cases, however, had higher perinatal mortality, and high rates of congenital anomaly. The overall neonatal outcome at NSW FTC for TRAP cases is similar to reported international outcomes.
当存在一个无心脏结构的不可存活双胎以及一个为无心双胎团块供血的可存活泵血双胎时，就会出现双胎反向动脉灌注序列（TRAP）。本研究旨在调查转诊至新南威尔士州胎儿治疗中心（NSW FTC）的合并TRAP的单绒毛膜多胎妊娠的管理及新生儿即时结局。
对2006年4月至2014年4月转诊至NSW FTC的多胎妊娠进行回顾性队列研究，回顾TRAP序列病例（n = 19，包括2例三胎病例）的数据，并与该科室管理的同期匹配的无并发症单绒毛膜双羊膜囊（MCDA）双胎妊娠样本（n = 45）的数据进行比较。
19例TRAP病例的主要管理方式为期待治疗10例（53%），射频消融（RFA）6例（32%），双极脐带凝固、羊水引流及终止妊娠各1例。6例RFA病例中有1例泵血双胎在术后<1周死亡。TRAP泵血胎儿与无并发症MCDA病例的平均出生孕周（35.1±5.0周 vs. 35.0±2.8周）和平均出生体重（2157±1019 g vs. 2245±537 g）相似。泵血双胎的存活率为81%（仅双胎情况），无并发症MCDA双胎的存活率为98%（P = 0.02），19例TRAP妊娠中有5例（26%）泵血胎儿有先天性异常。
TRAP妊娠与无并发症MCDA妊娠的平均出生孕周和平均出生体重相似。然而，TRAP病例的围产儿死亡率更高，先天性异常发生率也高。NSW FTC的TRAP病例的总体新生儿结局与国际报道的结局相似。
