Abstract：
There is some evidence that in twin reversed arterial perfusion sequence, intervention at early gestational age could prevent a spontaneous death of the pump twin, achieving a better global survival.
OBJECTIVE: To review the perinatal outcomes of early intervention in pregnancies complicated by twin reversed arterial perfusion (TRAP) sequence.
METHODS: A comprehensive search from inception to December 2022 was conducted on databases including MEDLINE, EMBASE, Cochrane Library and LILACS. All studies that reported intervention in twin or triplet pregnancy complicated with TRAP sequence at 12 + 0 to 16 + 6 weeks of gestation were eligible. A descriptive and bivariate analysis was performed.
RESULTS: Out of the 222 full-text articles, 44 studies reporting 108 cases of early intervention in TRAP sequence were included. A successful procedure was achieved in 105 (95.5 %) interventions: 89 (94.7 %) among twin pregnancies and 16(100 %) among triplet pregnancies. An overall livebirth rate was achieved in 75 patients (70.8 %): intrafetal laser group 55 (73.3 %), radiofrequency 10 (76.9 %) and endoscopic laser 3 (75.0 %). The median gestational age at delivery was 38 + 0 (37 + 4 - 39 + 4) weeks. The median treatment-delivery interval was 23 + 2 (IQR, 21 + 0-25 + 6) weeks. The most frequent adverse outcomes reported were preterm labor in 7 (13.7 %) patients. There were no severe adverse maternal outcomes.
CONCLUSIONS: Early intervention with intrafetal laser and radiofrequency in TRAP sequence achieves a livebirth rate of the pump twin of about 75 %.
OBJECTIVE: To review the perinatal outcomes of early intervention in pregnancies complicated by twin reversed arterial perfusion (TRAP) sequence.
METHODS: A comprehensive search from inception to December 2022 was conducted on databases including MEDLINE, EMBASE, Cochrane Library and LILACS. All studies that reported intervention in twin or triplet pregnancy complicated with TRAP sequence at 12 + 0 to 16 + 6 weeks of gestation were eligible. A descriptive and bivariate analysis was performed.
RESULTS: Out of the 222 full-text articles, 44 studies reporting 108 cases of early intervention in TRAP sequence were included. A successful procedure was achieved in 105 (95.5 %) interventions: 89 (94.7 %) among twin pregnancies and 16(100 %) among triplet pregnancies. An overall livebirth rate was achieved in 75 patients (70.8 %): intrafetal laser group 55 (73.3 %), radiofrequency 10 (76.9 %) and endoscopic laser 3 (75.0 %). The median gestational age at delivery was 38 + 0 (37 + 4 - 39 + 4) weeks. The median treatment-delivery interval was 23 + 2 (IQR, 21 + 0-25 + 6) weeks. The most frequent adverse outcomes reported were preterm labor in 7 (13.7 %) patients. There were no severe adverse maternal outcomes.
CONCLUSIONS: Early intervention with intrafetal laser and radiofrequency in TRAP sequence achieves a livebirth rate of the pump twin of about 75 %.
摘要：
有证据表明，在双胞胎反向动脉灌注序列中，在胎龄早期进行干预可以防止泵双胎的自发死亡，实现更好的全球生存。
目的：回顾双胎反向动脉灌注（TRAP）序列妊娠早期干预的围产期结局。
方法：从开始到2022年12月，对包括MEDLINE在内的数据库进行了全面搜索，EMBASE,Cochrane图书馆和LILACS。所有报道在妊娠12+0至16+6周时对双胎或三胎妊娠合并TRAP序列进行干预的研究均合格。进行描述性和双变量分析。
结果：在222篇全文文章中，44项研究报告了108例TRAP序列的早期干预。在105例（95.5％）干预措施中成功完成了手术：双胎妊娠89例（94.7％），三胎妊娠16例（100％）。75例患者（70.8％）的总体出生率：胎儿内激光组55例（73.3％），射频10（76.9%）和内窥镜激光3（75.0%）。分娩时的中位胎龄为38+0(37+4-39+4)周。中位治疗-分娩间隔为23+2(IQR，21+0-25+6）周。报告的最常见的不良结局是7例（13.7％）患者的早产。没有严重的不良产妇结局。
结论：在TRAP序列中进行胎儿内激光和射频的早期干预可使泵浦双胎的出生率约为75％。
目的：回顾双胎反向动脉灌注（TRAP）序列妊娠早期干预的围产期结局。
方法：从开始到2022年12月，对包括MEDLINE在内的数据库进行了全面搜索，EMBASE,Cochrane图书馆和LILACS。所有报道在妊娠12+0至16+6周时对双胎或三胎妊娠合并TRAP序列进行干预的研究均合格。进行描述性和双变量分析。
结果：在222篇全文文章中，44项研究报告了108例TRAP序列的早期干预。在105例（95.5％）干预措施中成功完成了手术：双胎妊娠89例（94.7％），三胎妊娠16例（100％）。75例患者（70.8％）的总体出生率：胎儿内激光组55例（73.3％），射频10（76.9%）和内窥镜激光3（75.0%）。分娩时的中位胎龄为38+0(37+4-39+4)周。中位治疗-分娩间隔为23+2(IQR，21+0-25+6）周。报告的最常见的不良结局是7例（13.7％）患者的早产。没有严重的不良产妇结局。
结论：在TRAP序列中进行胎儿内激光和射频的早期干预可使泵浦双胎的出生率约为75％。
