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Fetus

Poster Session 1

(224) Umbilical cord occlusion of twin reversed arterial perfusion (TRAP) sequence: laser photocoagulation vs radiofrequency ablation

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: TRAP sequence is rare (1:30,000 pregnancies) and associated with poor perinatal outcomes in high-risk cases. Surgical management via umbilical cord occlusion (UCO) has been shown to improve pump twin survival, but limited data are available comparing surgical techniques. The study objective was to review perinatal outcomes of patients with high-risk TRAP sequence who underwent mid-trimester UCO via laser photocoagulation vs radiofrequency ablation (RFA).

Study Design: This is a retrospective cohort study of all patients seen between 2006-2023 with high-risk TRAP sequence who underwent UCO at a gestational age (GA) of 16-26 weeks. Criteria used to classify TRAP sequence patients as high-risk and eligible for UCO included: (1) abdominal circumference of the acardiac twin greater than or equal to that of the pump twin, (2) polyhydramnios (maximum vertical pocket > 8 cm), (3) critically abnormal Doppler studies in the pump twin, (4) pump twin hydrops, or (5) monoamniotic twins. The primary outcome was 30-day survival of the pump twin.

Results:

Of 77 consecutive high-risk TRAP sequence patients that underwent UCO, perinatal outcomes were available in 74, of which 37 underwent UCO by laser and 37 by RFA. All gestations had at least 1 high-risk characteristic (Table); 63 were twins, 10 were triplets and 1 was quadruplets. The average GA of UCO was similar between the laser and RFA groups (20.5 ± 2.3 vs 20.7 ± 3.1 weeks, p=0.987). Five fetal demises occurred, 1 in the laser group (1/37, 2.7%) and 4 in the RFA group (4/37, 10.8%) (p=0.358).  Postoperative pump twin membrane detachment was a risk factor for demise (4/7 [57.1%] vs 10/67 [14.9%], OR 7.69 [1.47-33.33], p=0.015). The average GA at delivery was similar between groups (35.2 ± 4.6 vs 34.5 ± 5.7 weeks, p=0.812) groups. The 30-day neonatal survival rate was 91.9% (34/37) in the laser group and 89.2% (33/37) in the RFA group (aOR: 1.42 [0.27-7.46], p= 0.677).

Conclusion: No significant differences in perinatal outcomes were identified in patients with high-risk TRAP sequence who underwent UCO by laser vs RFA.