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Surgery Best for Twin Reversed Arterial Perfusion

However, surgery should be tailored to specific cases

FRIDAY, April 14 (HealthDay News) -- The best overall outcome for twin reversed arterial perfusion (TRAP) sequence is achieved with surgery, but the surgical approach and technique should be tailored to individual cases, according to a study in the April issue of the American Journal of Obstetrics & Gynecology.

Ruben A. Quintero, M.D., of the Florida Institute for Fetal Diagnosis and Therapy in Tampa, and colleagues studied 74 patients with TRAP, of whom 65 were candidates for surgery and 51 underwent umbilical cord occlusion. Of this subgroup, the overall perinatal survival rate was 65 percent (33 out of 51 patients) versus 42.9 percent (6 out of 14 patients) who were candidates for surgery but who did not undergo umbilical cord occlusion.

If the dividing membrane was not deliberately disrupted, perinatal surgical outcomes were much better than surgical candidates who were expectantly treated (22 out of 28 patients, 78.5 percent). In 23.5 percent of cases, it was possible to perform surgery within the sac of the TRAP fetus and this was associated with no incidence of premature rupture of the membranes, 83 percent perinatal survival and 36 weeks' gestational age at delivery.

"Patients with TRAP sequence who are treated with umbilical cord occlusion have a more favorable outcome relative to surgical candidates who do not undergo surgery, provided that the dividing membrane is not disrupted," the authors conclude.

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