ENDOSCOPIC LASER COAGULATION OF UMBILICAL-CORD VESSELS IN TWIN REVERSED ARTERIAL PERFUSION SEQUENCE

In monozygotic twin pregnancies with reversed arterial perfusion (TRAP) sequence, the donor twin is at high risk of perinatal death. This paper describes the use of endoscopic surgery in the management of this condition. In four cases of TRAP sequence presenting at 17, 20, 26 and 28 weeks' gestation, respectively, an endoscope was introduced into the uterus under local anesthesia and a Nd-YAG laser was used to coagulate the umbilical cord vessels of the acardiac twin. Laser coagulation was successful in arresting blood flow to the acardiac fetus in the cases treated at 17 and 20 weeks, and healthy infants were delivered at term. In the pregnancies treated at 26 and 28 weeks, the umbilical cords were very edematous and laser coagulation failed to arrest blood flow; healthy infants were delivered after spontaneous labor at 29 weeks. These findings suggest that, during mid-gestation, endoscopic laser coagulation of the umbilical cord vessels of the acardiac twin is an effective method o treating TRAP sequence. In later pregnancy, alternative methods of treatment are needed.