Fetal therapy in twin reversed arterial perfusion sequence pregnancies with alcohol ablation or bipolar cord coagulation.
OBJECTIVE
We aimed to evaluate perinatal outcome of seven pregnancies with twin reserve arterial perfusion sequence.


METHODS
The study group included seven cases of acardiac twins. Out of seven acardiac twins, two cases were in follow-up without any interventions. We performed four alcohol ablation and one bipolar coagulation. For alcohol ablation, a 20-gauge needle guided with color Doppler USG was directed to abdominal insertion site of the single umbilical artery of the acardiac twin, and 1.0-2.0 mL of absolute alcohol was injected. For bipolar coagulation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm bipolar forceps. The procedures were performed under the guidance of transabdominal ultrasonography.


RESULTS
Gestational age of the cases at diagnosis and at delivery was 15-32 and 17-38 weeks, respectively. Two cases without intervention were lost at 17 and 32 weeks. The mean time of procedure for bipolar coagulation and alcohol ablation were 30 and 10 min, respectively. One of the four cases of alcohol ablation group was aborted although alcohol ablation was successful. The other one case was aborted after alcohol ablation due to lost of fetal cardiac activity of the pump fetus. In two other cases, umbilical cord ablation with alcohol was successful, and they delivered live fetuses at 36 and 38 weeks. In one case we performed bipolar cord coagulation successfully, and the case delivered a live fetus at 39 weeks. The overall survival rate for intrauterine surgery was 60% (N=3/5).


CONCLUSIONS
In twin reversed arterial perfusion sequence pregnancies with findings of poor prognosis, alcohol ablation or bipolar cord coagulation as fetal therapy under the guidance of ultrasonography can be done successfully, and should be offered as a choice to families upon discussion of intervention or follow-up with own complications.
Gul
Ahmet
A
Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Women and Children Hospital, Istanbul, Turkey.
Gungorduk
Kemal
K
Yildirim
Gokhan
G
Gedikbasi
Ali
A
Yildirim
Dogukan
D
Ceylan
Yavuz
Y
D017115:Catheter Ablation; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011272:Pregnancy, Multiple; D014463:Ultrasonography; D014470:Umbilical Cord / Q000000981:diagnostic imaging
D000431:Ethanol