Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord

Ultrasound Obstet Gynecol. 2006 Oct;28(5):688-91. doi: 10.1002/uog.3816.


Objective: To assess the feasibility and outcome of fetoscopic laser coagulation in pregnancies with twin reversed arterial perfusion (TRAP) sequence.

Methods: In a prospective multicenter study, percutaneous fetoscopic laser coagulation of placental anastomoses (n = 18) or the umbilical cord of the acardiac twin (n = 42) was performed in 60 consecutive pregnancies at a median gestational age of 18.3 (range, 14.3-24.7) weeks under local or locoregional anesthesia.

Results: Vascular coagulation with arrest of blood flow was achieved in 82% (49/60) of cases by laser alone and in a further 15% (9/60) by laser coagulation in combination with bipolar forceps. The overall survival rate of the pump twin was 80% (48/60). Median gestational age at delivery was 37.4 (range, 23.7-41.4) weeks and the median interval between the procedure and delivery was 18.2 (range, 1.1-25.7) weeks. Median birth weight was 2720 (range, 540-3840) g. Preterm premature rupture of membranes before 34 weeks' gestation occurred in 18% (11/60) at a median of 62 (range, 1-102) days after the procedure. However, only two (3%) women delivered within 28 days of the procedure.

Conclusions: Fetoscopic laser coagulation of placental vascular anastomoses or the umbilical cord of the acardiac twin is an effective treatment of TRAP sequence, with a survival rate of 80%, and 67% of pregnancies with surviving pump twins going beyond 36 weeks' gestation without further complications.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arteriovenous Fistula / surgery
  • Birth Weight
  • Female
  • Fetal Heart / abnormalities
  • Fetofetal Transfusion / surgery*
  • Fetoscopy
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Laser Coagulation / methods*
  • Placenta / blood supply
  • Placenta / surgery*
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy Reduction, Multifetal / methods*
  • Pregnancy, Multiple
  • Prospective Studies
  • Treatment Outcome
  • Umbilical Cord / surgery*