Outcome of Twin Reversed Arterial Perfusion Sequence: 15-Year Experience in a Tertiary Hospital in Hong Kong

Abstract

Objective: To evaluate our local experience of twin reversed arterial perfusion sequence.
Methods: This was a retrospective cohort study of all twin pregnancies complicated by twin reversed arterial perfusion sequence that were managed at a university teaching hospital in Hong Kong from 1 January 1998 to 31 December 2012.
Results: Of 16 cases identified, two were excluded and 14 were analysed. The median (range) gestation at
diagnosis was 16.0 (10.8-24.3) weeks. Seven cases were treated conservatively and seven were treated with
surgical intervention. Comparison of surgical and conservative treatment showed that the former was associated with a trend for better survival (71% vs. 43%), and less miscarriage (14% vs. 43%), preterm delivery (20% vs. 33%), and small for gestational age (0 vs. 33%), although these were not statistically significant. There was no significant difference in median gestation at delivery (37.0 vs. 37.4 weeks). Two cases (28.6%) with treatment failure and one other case (14.3%) had procedure-related complications. In the small-size acardiac twin subgroup (acardiac-to-pump twin size ratio <50%), both surgical and conservative treatments had excellent survival (100%). Of the six cases diagnosed in the first trimester, three (50%) ended in miscarriage before 16 weeks of gestation, and all were associated with a large-size (i.e. acardiac-to-pump twin size ratio ≥50%) acardiac twin.
Conclusions: Surgical intervention for twin reversed arterial perfusion sequence tended to improve survival with few adverse events. Our surgical intervention results were comparable with other studies. Conservative management appears to be safe for twin reversed arterial perfusion with a small acardiac twin. Diagnosis of twin reversed arterial perfusion sequence in the first trimester was associated with a high miscarriage rate at or before 16 weeks, especially with a large-size acardiac twin.