Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single-center experience

Am J Obstet Gynecol. 2007 Oct;197(4):399.e1-3. doi: 10.1016/j.ajog.2007.07.051.


Objective: The objective of the study was to review perinatal outcomes in pregnancies treated with intrafetal radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence.

Study design: Perinatal outcome data from a quaternary care referral center were abstracted from a chart review of pregnancies with TRAP sequence treated in the midtrimester with umbilical cord RFA of the perfused twin.

Results: Twenty-one pregnancies with TRAP sequence were evaluated. Two women had a pump twin demise prior to therapy, 1 with trisomy 21 declined treatment. Four of 20 were treated successfully with RFA but remain undelivered, and 1 was treated with fetoscopic cord coagulation. Twelve of 13 pump twins treated with RFA (94%) survived to 30 days of life. Mean preoperative cardiac combined cardiac output was 588 mL/kg and pump/twin ratio was 0.7 (range 0.4 to 1.1). The effect of RFA on postoperative cardiac output was variable (6-85%). The average gestational age at birth was 37 weeks (range 26-39 weeks).

Conclusion: Primary therapy with RFA is a successful modality for pregnancies complicated by TRAP sequence.

MeSH terms

  • Cardiac Output / physiology
  • Catheter Ablation / methods*
  • Diseases in Twins / surgery*
  • Female
  • Fetofetal Transfusion / surgery*
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Twins