The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester

Am J Obstet Gynecol. 2010 Sep;203(3):213.e1-4. doi: 10.1016/j.ajog.2010.04.018. Epub 2010 Jun 3.


Objective: The aim of this study was to document the mortality of twin reversed arterial perfusion (TRAP) sequence from the first trimester to planned intervention at 16-18 weeks.

Study design: A retrospective review was performed of the outcome of monochorionic twin pregnancies diagnosed with twin reversed arterial perfusion sequence in the first trimester.

Results: Twenty-six pregnancies were diagnosed with twin reversed arterial perfusion sequence in the first trimester: 2 opted for termination of pregnancy and 24 opted for prophylactic intervention to arrest the reversed flow, which was planned at 16-18 weeks. In 8 of 24 (33%) pregnancies, spontaneous death of the pump twin occurred between diagnosis and planned intervention. In 5 of 24 (21%), there was a spontaneous arrest of flow; whereas, in 11 (46%) there was persistent flow toward the acardiac twin at 16-18 weeks.

Conclusion: Twin reversed arterial perfusion carries a high mortality between the first and early second trimester.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Induced / statistics & numerical data
  • Abortion, Spontaneous / epidemiology
  • Adult
  • Female
  • Fetal Death / epidemiology
  • Fetofetal Transfusion / diagnosis*
  • Fetofetal Transfusion / mortality*
  • Fetofetal Transfusion / surgery
  • Fetoscopy
  • Humans
  • Laser Coagulation
  • Live Birth / epidemiology
  • Pregnancy
  • Pregnancy Trimester, First*
  • Retrospective Studies
  • Twins
  • Ultrasonography
  • Umbilical Cord / diagnostic imaging
  • Umbilical Cord / surgery