TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery

Gabriele Tonni, Gianpaolo Grisolia, Paolo Zampriolo, Federico Prefumo, Anna Fichera, Paola Bonasoni, Mathilde Lefebvre, Suonavy Khung-Savatovsky, Fabien Guimiot, Jonathan Rosenblatt, Edward Araujo Júnior

Research output: Contribution to journalArticle

Abstract

Introduction: Ablation of the acardiac twin umbilical cord in the TRAP protects the normal donor twin. Materials and methods: Two case descriptions, one of interstitial laser photocoagulation and one of laser umbilical cord occlusion (L-UCO) of the acardiac twin in monochorionic monoamniotic pregnancies are reported. Results: L-UCO in two pregnancies with TRAP syndrome in the second trimester resulted in intrauterine fetal death in both cases after 1 month. Case 1 had no detectable cause of fetal death. Case 2 had rupture of the amniotic sac causing anhydramnios and acute chorioamnionitis. A groove on the umbilical cord of the normal twin indicated a cord stricture due to cord entanglement. Conclusion: Our experience confirms that the best timing and optimal treatment of MC/MA twins complicated by TRAP sequence still remains a controversial clinical issue. Cord entanglement may continue be a potential clinical risk factor for adverse perinatal outcome even after ablation therapy.

Original languageEnglish
JournalFetal and Pediatric Pathology
DOIs
Publication statusAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Fetoscopy
Umbilical Cord
Laser Therapy
Lasers
Fetal Death
Chorioamnionitis
Pregnancy
Light Coagulation
Second Pregnancy Trimester
Rupture
Cause of Death
Pathologic Constriction
Therapeutics

Keywords

  • Cristal and Realistic Vue
  • fetal pathology
  • fetoscopic laser photocoagulation
  • monochorionic/monoamiotic twins
  • TRAP sequence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pathology and Forensic Medicine

Cite this

TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins : Two Cases Treated with Fetoscopic Laser Surgery. / Tonni, Gabriele; Grisolia, Gianpaolo; Zampriolo, Paolo; Prefumo, Federico; Fichera, Anna; Bonasoni, Paola; Lefebvre, Mathilde; Khung-Savatovsky, Suonavy; Guimiot, Fabien; Rosenblatt, Jonathan; Júnior, Edward Araujo.

In: Fetal and Pediatric Pathology, 01.01.2019.

Research output: Contribution to journalArticle

Tonni, G, Grisolia, G, Zampriolo, P, Prefumo, F, Fichera, A, Bonasoni, P, Lefebvre, M, Khung-Savatovsky, S, Guimiot, F, Rosenblatt, J & Júnior, EA 2019, 'TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery', Fetal and Pediatric Pathology. https://doi.org/10.1080/15513815.2018.1526240
Tonni, Gabriele ; Grisolia, Gianpaolo ; Zampriolo, Paolo ; Prefumo, Federico ; Fichera, Anna ; Bonasoni, Paola ; Lefebvre, Mathilde ; Khung-Savatovsky, Suonavy ; Guimiot, Fabien ; Rosenblatt, Jonathan ; Júnior, Edward Araujo. / TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins : Two Cases Treated with Fetoscopic Laser Surgery. In: Fetal and Pediatric Pathology. 2019.
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