Tonni Gabriele, Granese Roberta, Incognito Giosuè Giordano, Grisolia Gianpaolo, Lituania Mario, Sepulveda Waldo, de Andrade Valter Lacerda, Ruano Rodrigo
Department of Obstetrics and Neonatology, and Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), ASL Reggio Emilia, Reggio Emilia, Italy.
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, "G. Martino" University Hospital, Messina, Italy.
Prenat Diagn. 2025 Mar;45(3):396-422. doi: 10.1002/pd.6725. Epub 2025 Jan 21.
Twin reversed arterial perfusion (TRAP) sequence is an uncommon disease affecting monochorionic twin pregnancies. The diagnosis can be made by ultrasound allowing to plan optimal antenatal management. An electronic search was conducted from inception to July 2024 to systematically evaluate and compare the outcomes of different intrauterine interventions in this condition. Eighty-two studies were included, and 859 women with a prenatal ultrasound diagnosis of TRAP sequence with a total of 1763 fetuses were studied. The mean maternal age was 24.2 years (range 19-40) and the mean gestational age at diagnosis was 19.6 weeks (range 10-32). A total of 792 pregnancies were reported in which a fetal intervention was performed over the past 35 years. The mean gestational age at fetal intervention was 22.1 weeks (range 11-32). The two most frequent fetal interventions were radiofrequency ablation, performed in 293 cases and laser umbilical cord coagulation in 140 cases. Overall, 684 out of 828 non-acardiac fetuses following fetal intervention survived (82.6%) compared with 49 out of 76 (64.5%) non-acardiac fetuses in pregnancies managed expectantly (p = 0.0001). A higher survival rate was seen in fetuses undergoing umbilical cord ligation (100%) although this procedure was performed in only 8 women. Survival rates were 88.9%, 79.9%, 78.9% and 77.9% for monopolar coagulation of the umbilical cord, laser coagulation of the umbilical cord, fetoscopic laser ablation of placental anastomoses and radiofrequency ablation, respectively. Our results show that the survival rate is higher in patients with TRAP who have a prenatal intervention compared with those who have prenatal expectant management. The survival rate varies depending on the modality used for the prenatal intervention. Future studies are necessary to investigate the impact of the gestational age at the time of the procedure on the survival rate depending on the prenatal therapeutic modality.
双胎反向动脉灌注序列（TRAP）是一种影响单绒毛膜双胎妊娠的罕见疾病。可通过超声进行诊断，以便规划最佳的产前管理。从开始到2024年7月进行了电子检索，以系统评估和比较针对这种情况的不同宫内干预的结果。纳入了82项研究，对859名经产前超声诊断为TRAP序列的妇女及总共1763名胎儿进行了研究。产妇平均年龄为24.2岁（范围19 - 40岁），诊断时的平均孕周为19.6周（范围10 - 32周）。过去35年共报告了792例进行了胎儿干预的妊娠。胎儿干预时的平均孕周为22.1周（范围11 - 32周）。两种最常见的胎儿干预是射频消融，共293例，以及激光脐带凝固，共140例。总体而言，胎儿干预后828例无心畸形胎儿中有684例存活（82.6%），而期待治疗的妊娠中76例无心畸形胎儿中有49例存活（64.5%）（p = 0.0001）。脐带结扎的胎儿存活率更高（100%），尽管仅8名妇女接受了该手术。脐带单极凝固、脐带激光凝固、胎盘吻合镜下激光消融和射频消融的存活率分别为88.9%、79.9%、78.9%和77.9%。我们的结果表明，与产前期待管理的患者相比，接受产前干预的TRAP患者存活率更高。存活率因产前干预所用方式而异。有必要进行进一步研究，以调查手术时孕周对存活率的影响，具体取决于产前治疗方式。
