Prognosis for Monochorionic Twins with Twin Reversed Arterial Perfusion Sequence / 中山大学学报(医学科学版)

ABSTRACT

[Objective] The purpose of this study was to evaluate the association of ultrasound findings and different treatments with the prognosis of the pump twin in twin reversed arterial perfusion sequence (TRAP).[Methods] The 55 cases that were diagnosed as TRAP during the period from January 4th 2010 and August 31st 2015 were included.Ultrasound appearances of monochorionic twins were documented in detail when the twins were diagnosed with TRAP initially.At the initial evaluation,presence or absence of the following abnormalities were documented,including the ratio of the acardiac twin to the weight of the pump twin,hydrops fetalis in the pump twin,cardiomegaly in the pump twin,polyhydramnios in the pump twin,oligohydramnios in the acardiac twin and different treatments.The relationship between these ultrasound characteristics and different treatments with mortality of pump twin were analyzed with logistic regression.[Results] A total of 55 cases with TRAP were diagnosed in our institution and three cases were lost to follow up.Selective reduction was performed in 21 cases,termination of pregnancies in 13 and expectant management in 18.Excluding the cases that underwent termination of pregnancy,the remaining 39 cases were divided into two groups according treatment,expectant management group (n=18) and selective reduction group (n=21).Overall survival rate of the pump twin in these two groups was 66.7％ and 71.4％,respectively,P =0.748.The markers of perinatal outcome were not significantly different between expectant management group and selective reduction group.Logistic regression demonstrated that cardiomegaly in the pump twin (OR=21.73,95％CI1.15 ～ 203.89,P ＜ 0.001) were significant correlated with mortality of the pump twin.[Conclusion] The prognosis markers were not significantly different between conservative management and selective reduction group.Cardiomegaly in the pump twin should be considered as risk predictors for mortality of the pump twin in TRAP.