title: Forty cases of twin reversed arterial perfusion sequence treated with radio frequency ablation using the multistep coagulation method: a single-center experience.
abstract: OBJECTIVE
  To report the pregnancy outcomes of patients with twin reversed arterial perfusion (TRAP) sequence treated by radiofrequency ablation (RFA).
  
  
  METHODS
  This was a retrospective study of TRAP sequences treated in a single center between March 2002 and February 2015. Forty patients underwent RFA with expandable tines through a multistep coagulation method between 15 and 26 gestational weeks. The primary outcome was neonatal survival to discharge.
  
  
  RESULTS
  The overall survival of the pump twin was 85%. The survival rates in monochorionic-monoamniotic (MCMA) pregnancies and monochorionic-diamniotic pregnancies were 66.7% (4/6) and 87.9% (29/33), respectively. One triplet was treated successfully and delivered at 36 weeks of gestation. One of 35 live births (2.9%) had preterm premature rupture of membranes less than 34 weeks, resulting in infant death. In five intrauterine pump twin deaths, two cases were MCMA twins with cord entanglement, and three cases were MCDA twins with acardius anceps.
  
  
  CONCLUSIONS
  Our study supports the effectiveness of RFA for TRAP sequence after 15 weeks of gestation. The presence of MCMA twins or acardius anceps is associated with a high risk of pump twin death after RFA. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Sugibayashi
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Katsusuke
authors.initials: K
authors.lastname: Ozawa
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sumie
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Wada
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
mesh_terms: D000328:Adult; D017115:Catheter Ablation; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D007223:Infant; D066088:Infant Death; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D011262:Pregnancy Trimester, Second; D059286:Pregnancy, Triplet; D059285:Pregnancy, Twin; D012189:Retrospective Studies