title: Experience of fetoscopic laser photocoagulation and cord transection for twin-reversed arterial perfusion sequence.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the usefulness of fetoscopic laser photocoagulation of placental communicating vessels or umbilical cord for twin-reversed arterial perfusion (TRAP) sequence.
  
  
  METHODS
  We report a retrospective case series of all cases of TRAP sequence identified from 2006 to 2014 at out institutions. Fetoscopic laser photocoagulation of placental arterioarterial and venovenous anastomoses was performed in diamniotic twins, and in cases of monoamniotic twins we performed laser photocoagulation and transection of the umbilical cord of the acardiac twin to prevent cord entanglement. Pregnancy and perinatal outcomes were estimated.
  
  
  RESULTS
  Ten cases were included in the study. The median gestational age at procedure was 21.3 weeks (range, 16.7-27.3 weeks). All cases completed the procedure. Two cases were treated with laser photocoagulation and transection of the umbilical cord of the acardiac twin. No major immediate complications were noted. Preterm rupture of membranes occurred in four cases (40%). One case resulted in miscarriage. The other fetuses were delivered alive. Median gestational age at delivery was 35.4 weeks (range, 25.6-42.0 weeks). Median interval of treatment to delivery was 85 days (range, 43-153 days). Five out four infants were delivered preterm. The overall neonatal survival was 9/10.
  
  
  CONCLUSIONS
  This case series demonstrated favorable outcome, and fetoscopic laser photocoagulation seems to be a useful treatment for TRAP sequence. In particular, transection of the umbilical cord is effective to prevent cord entanglement of monoamniotic twins.
authors.affiliation: Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.|Department of Obstetrics and Gynecology, Tokuyama Central Hospital, Shunan, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Takano
authors.affiliation: Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Murata
authors.affiliation: Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.
authors.forename: Michihisa
authors.initials: M
authors.lastname: Fujiwara
authors.affiliation: Department of Obstetrics and Gynecology, Tokuyama Central Hospital, Shunan, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Hirata
authors.affiliation: Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.|Department of Obstetrics and Gynecology, Tokuyama Central Hospital, Shunan, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
mesh_terms: D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014430:Twins, Monozygotic
keywords: acardiac twin; cord transection; fetoscopy; laser surgery; twin-reversed arterial perfusion sequence