Abstract
A-cardiac twin pregnancy is a rare complication occurs in 1,46 %of all monochorionic twin pregnancies. The fetus whose heart and upper body haven’t been developed and the rest of the body has its blood supply from a branch of the umbilical artery can be considered a healthy fetus? . Usually the complication can be diagnosed in the end of 1st trimester and if the anastomosis of circulation isn’t separated on time, the mortality rate for the healthy fetus who has the blood pumper role will be 55 %. So the obstetric problems such as preterm delivery increase. The death for the fetus who has no heart is certain. Therefore, stopping the blood circulation of the fetus with cardiac abnormality is the main approach to prevent problems such as the lose of the healthy fetus and preterm delivery. We aim to discuss the clinical management of two cases which have been diagnosed with TRAP Twin Reversed Arterial Transfusion in their 11th week of gestation and have had totally different prognosis
Keywords
References
- Hartge DR, Weichert J. Prenatal diagnosis and outcome of multiple pregnancies with reversed arterial perfusion (TRAP-sequence). Arch Gynecol Obstet 2012;286:81–8. [CrossRef]
- Moore TR, Gale S, Benirschke K. Perinatal outcome of forty nine pregnancies complicated by a cardiac twinning. Am J Obstet Gynecol 1990;163:907–12. [CrossRef]
- Lewi L, Valencia C, Gonzales E, Deprest J, Nikolaides KH. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am J Obstet Gynecol 2010;203:213.e1–4. [CrossRef]
- Sepulveda W, Sfeir D, Reyes M, Martinez J. Severe polyhydramnios in twin reversed arterial perfusion sequence: successful management with intrafetal alcohol ablation of a cardiac twin and amnio drainage. Ultrasound Obstet Gynecol 2000;16:260–3. [CrossRef]
- Weisz B, Peltz R, Chayen B, Oren M, Zalel Y, Achiron R, Lipitz S. Tailored management of twin reversed arterial perfusion (TRAP) sequence. Ultrasound Obstet Gynecol 2004;23:451–5. [CrossRef]
- Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J. Twin reversed arterial perfusion: Fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006;28:688–91. [CrossRef]
- Galllot D, Laurichesse H, Lemery D. Selective feticide in monochorionic twin pregnancies by ultrasound-guided umbilical cord occlusion. Ultrasound Obstet Gynecol 2003;22:484–8. [CrossRef]
- Hirose M, Murata A, Kita N, Aotani H, Takebayashi K, Noda Y. Successful intrauterine treatment with radiofrequency ablation in a case of a cradiac twin pregnancy complicated with a hydropic pump twin. Ultrasound Obstet Gynecol 2004;23:509–12. [CrossRef]
- Ferianec V, Redecha M, Papcun P, Krizko M, Holly I, Holoman K. Successful ablation of a cardiac twin with histoacryl. Taiwanese J Obstet Gynecol 2016;55:109–11. [CrossRef]
- Quintero RA, Chmait RH, Murakoshi T, Pankrac Z, Swiatkowska M, Bornick PW, Allen MH. Surgical management of twin reversed arterial perfusion sequence. Am J Obstet Gynecol 2006;194:982–91. [CrossRef]
- Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J. Twin reversed arterial perfusion: Fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006;28:688–91. [CrossRef]
- Robyr R, Yamamato M, Ville Y. Selective feticide in complicated monochorionic twin pregnancies using ultrasound-guided bipolar cord coagulation. BJOG 2005;112:1344–8. [CrossRef]
- Guven MA, Koc O, Bodur H, Erkanlı S, Bagis T, Usal D. Acardiac twin pregnancy: successful intrauterine ablative treatment with alcohol at 14 weeks of gestation. Clin Exp Obstet Gynecol 2016;43:460–2.
- Lee H, Bebbington M, Crombleholme TM; North American Fetal Therapy Network. The North America Fetal Therapy Network Registry data on outcomes of radiofrequency ablation for twin reversed arterial perfusion sequence. Fetal Diagn Ther 2013;33:224– 9. [CrossRef]
Abstract
Akardiyak ikiz gebelik, monokoryonik ikiz gebeliklerin %1,46’sında izlenen nadir bir komplikasyondur 1 . Kalp ve genellikle üst ekstremite dahil gövdenin üst bölümü gelişmemiş olan ikiz eşi, sağlam görünümlü ikiz eşinin umbilikal arterinden aldığı bir anastomoz ile beslenir 2 . Çoğu zaman 1. trimester sonlarında tanı alabilen bu komplikasyonda, dolaşımlar arasındaki anastomotik bağlantı zamanında ayrılmaz ise pompa görevi gören sağlıklı ikiz eşi için mortalite %55’lere ulaştığı gibi preterm doğum gibi obstetrik sorunlar da artmaktadır 3 . Akardiyak ikiz eşi için mortalite kaçınılmazdır. Bu yüzden akardiyak ikiz eşinin dolaşımının durdurulması çoğu vakada sağlıklı görünen fetusun kaybı ve preterm doğum gibi sorunların önlenmesinde temel yaklaşımdır 3 . Bu olgu sunumunda 11. gebelik haftasında tanı alan ancak prognozu tamamı ile farklı olan 2 TRAP Twin Reversed Arterial Transfusion olgusu ve klinik yönetimlerini tartışmayı amaçladık
Keywords
References
- Hartge DR, Weichert J. Prenatal diagnosis and outcome of multiple pregnancies with reversed arterial perfusion (TRAP-sequence). Arch Gynecol Obstet 2012;286:81–8. [CrossRef]
- Moore TR, Gale S, Benirschke K. Perinatal outcome of forty nine pregnancies complicated by a cardiac twinning. Am J Obstet Gynecol 1990;163:907–12. [CrossRef]
- Lewi L, Valencia C, Gonzales E, Deprest J, Nikolaides KH. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am J Obstet Gynecol 2010;203:213.e1–4. [CrossRef]
- Sepulveda W, Sfeir D, Reyes M, Martinez J. Severe polyhydramnios in twin reversed arterial perfusion sequence: successful management with intrafetal alcohol ablation of a cardiac twin and amnio drainage. Ultrasound Obstet Gynecol 2000;16:260–3. [CrossRef]
- Weisz B, Peltz R, Chayen B, Oren M, Zalel Y, Achiron R, Lipitz S. Tailored management of twin reversed arterial perfusion (TRAP) sequence. Ultrasound Obstet Gynecol 2004;23:451–5. [CrossRef]
- Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J. Twin reversed arterial perfusion: Fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006;28:688–91. [CrossRef]
- Galllot D, Laurichesse H, Lemery D. Selective feticide in monochorionic twin pregnancies by ultrasound-guided umbilical cord occlusion. Ultrasound Obstet Gynecol 2003;22:484–8. [CrossRef]
- Hirose M, Murata A, Kita N, Aotani H, Takebayashi K, Noda Y. Successful intrauterine treatment with radiofrequency ablation in a case of a cradiac twin pregnancy complicated with a hydropic pump twin. Ultrasound Obstet Gynecol 2004;23:509–12. [CrossRef]
- Ferianec V, Redecha M, Papcun P, Krizko M, Holly I, Holoman K. Successful ablation of a cardiac twin with histoacryl. Taiwanese J Obstet Gynecol 2016;55:109–11. [CrossRef]
- Quintero RA, Chmait RH, Murakoshi T, Pankrac Z, Swiatkowska M, Bornick PW, Allen MH. Surgical management of twin reversed arterial perfusion sequence. Am J Obstet Gynecol 2006;194:982–91. [CrossRef]
- Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J. Twin reversed arterial perfusion: Fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006;28:688–91. [CrossRef]
- Robyr R, Yamamato M, Ville Y. Selective feticide in complicated monochorionic twin pregnancies using ultrasound-guided bipolar cord coagulation. BJOG 2005;112:1344–8. [CrossRef]
- Guven MA, Koc O, Bodur H, Erkanlı S, Bagis T, Usal D. Acardiac twin pregnancy: successful intrauterine ablative treatment with alcohol at 14 weeks of gestation. Clin Exp Obstet Gynecol 2016;43:460–2.
- Lee H, Bebbington M, Crombleholme TM; North American Fetal Therapy Network. The North America Fetal Therapy Network Registry data on outcomes of radiofrequency ablation for twin reversed arterial perfusion sequence. Fetal Diagn Ther 2013;33:224– 9. [CrossRef]
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | March 1, 2019 |
| Published in Issue | Year 2019Issue: 1 |