Analysis of cases complicated by twin reversed arterial perfusion sequence in monochorionic twins: A case series of 14 patients from a single tertiary care center.

OBJECTIVE

Twin reversed arterial perfusion (TRAP) sequence is a rare condition in monochorionic twin pregnancies. This study aimed to present the experience of our clinic, management, treatment, and outcomes of cases complicated by TRAP sequence.

METHODS

Fourteen cases diagnosed with TRAP sequence and managed between March 2021 and October 2024 were included. Demographic characteristics, mean gestational age at the time of intervention, intervention type, and obstetric outcomes were analyzed.

RESULTS

A total of 14 cases were included in the study with 10 fetal interventions. Intrafetal laser (IFL) ablation therapy was performed in four cases, while microwave ablation (MWA) therapy was performed in six cases. Among patients undergoing IFL therapy, one resulted in a live birth at 34 weeks, two cases resulted in pregnancy loss within the first week after the procedure, and the fourth case resulted in intrauterine exitus 7 weeks after the procedure. In the MWA group, four cases resulted in live births. There was a term delivery in two cases, while the other two cases had preterm labor. One of the remaining two pregnancies resulted in intrauterine demise, while the other resulted in postpartum exitus. The success rate of the MWA technique was 67%.

CONCLUSION

The study data demonstrate a high risk of spontaneous pregnancy loss without intervention. Treatment modalities such as MWA and IFL coagulation have been shown to improve survival outcomes.