Department of Obstetrics, Gynecology and Reproductive Services, University of Texas Health Science Center at Houston, United States; The Fetal Center at Children's Memorial Hermann Hospital, United States.
Department of Obstetrics, Gynecology and Reproductive Services, University of Texas Health Science Center at Houston, United States; The Fetal Center at Children's Memorial Hermann Hospital, United States.
Best Pract Res Clin Obstet Gynaecol. 2022 Nov;84:127-142. doi: 10.1016/j.bpobgyn.2022.03.006. Epub 2022 Mar 29.
Twin reverse arterial perfusion (TRAP) sequence is a severe anomaly in monochorionic twins where one twin has profound corporeal underdevelopment and acardia. The normal "pump" co-twin provides blood flow to the acardiac twin through placental anastomoses which may lead to cardiac failure and pump twin demise as well as preterm delivery from severe polyhydramnios. Treatments include radiofrequency ablation, bipolar cord coagulation, and intrafetal laser with each aimed at occluding blood flow to the acardiac twin. However, none of these modalities has proven superior in terms of either pump twin survival or minimization of complications, including preterm premature rupture of membranes, preterm birth, or unexpected co-twin demise. The optimal timing of treatment is also unknown, without clear indications for intervention versus expectant management. Very early treatment of TRAP (i.e., <16 weeks) has been proposed to reduce first-trimester demise; however, this approach remains experimental. Further investigation is required to determine the best treatment and timing of intervention for TRAP.
双胎反向动脉灌注（TRAP）序列是一种严重的单绒毛膜双胞胎异常，其中一个双胞胎存在严重的身体发育不全和无心畸形。正常的“泵”双胞胎通过胎盘吻合为无心双胞胎提供血流，这可能导致心脏衰竭和泵双胞胎死亡，以及严重羊水过多导致的早产。治疗方法包括射频消融、双极脐带凝固和胎儿内激光，每种方法都旨在阻断无心双胞胎的血流。然而，这些方法在泵双胞胎的存活率或最小化并发症方面都没有被证明是优越的，包括胎膜早破、早产或意外的同卵双胞胎死亡。最佳治疗时机也尚不清楚，没有明确的干预与期待管理的指征。有人提出对 TRAP 进行非常早期的治疗（即<16 周），以降低早孕期的死亡风险；然而，这种方法仍处于实验阶段。需要进一步的研究来确定 TRAP 的最佳治疗和干预时机。
