Fetoscopic laser photocoagulation of placental communicating vessels for twin-reversed arterial perfusion sequence.

Twin-reversed arterial perfusion (TRAP) sequence is a rare and compromised complication in monochorionic pregnancies. The retrograde blood flow through placental communicating vessels is mainly involved to develop the syndrome. Increased cardiac output in the pump twin can lead to severe clinical manifestations. Various surgical techniques to occlude vascular communications between the pump twin and acardiac twin have been reported. A woman with TRAP sequence, at 22 weeks of gestation, complicated with progressive polyhydramnios underwent fetoscopic laser photocoagualtion of vascular communications on the placental surface. Fetoscopic observation demonstrated one artery-to-artery anastomosis and one venous-to-venous anastomosis from the pump twin to the acardiac twin, and these communications were successfully photocoagulated. The patient delivered a 2308-g female infant at 34 weeks and 1 day of gestation, following premature rupture of membrane. The infant is now 1 year old without any neurological problem. Fetoscopic laser photocoagulation of placental communicating vessels can be the procedure of choice for TRAP sequence.