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

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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

Tonni, G., Grisolia, G., Zampriolo, P., Prefumo, F., Fichera, A., Bonasoni, P., Lefebvre, M., Khung-Savatovsky, S., Guimiot, F., Rosenblatt, J., & Júnior, E. A. (Accepted/In press). 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