Pregnancy management tactics in reversed arterial perfusion syndrome
- Authors: Kostyukov K.V.1, Gladkova K.A.1, Tetruashvili N.K.1
-
Affiliations:
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
- Issue: No 11 (2018)
- Pages: 44-49
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/248298
- DOI: https://doi.org/10.18565/aig.2018.11.44-49
- ID: 248298
Cite item
Open Access
Access granted
Abstract
Objective. To compare the efficiency of surgical and medical management tactics for RAPS-complicated pregnancy. Subjects and methods. Perinatal outcomes were retrospectively analyzed in 47patients with multiple pregnancy complicated by RAPS who had been examined and treated at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, in 2010 to 2017. According to the proposed pregnancy management tactics, the patients were divided into two groups: 1) 17 patients who had undergone medical pregnancy management; 2) 28 pregnant women who had intrauterine treatment. According to the type of an operation performed, Group 2 was divided into two Subgroups A and B. The findings were processed using descriptive statistical methods. Results. In Group 1 including patients undergoing medical management tactics, an unfavorable outcome was observed in 9 (52.9%) cases mainly due to the progression of pump fetal cardiomyopathy and polyhydramnios. The mean delivery time in this group was 32.3 ± 5.4 weeks. A favorable outcome was observed in 78.6% of cases in Group 2, with 77.3 and 83.3% in Subgroup A and B, respectively. The mean delivery time in Group 2 was 34.5+3.1 weeks. Conclusion. The rate of a favorable RAPS-complicated pregnancy outcome was significantly higher in the intrauterine treatment group than that in the medical management tactics group (78.6 and 47.1%, respectively; P = 0.0023).
Full Text
About the authors
Kirill V. Kostyukov
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: kostyukov_k@yahoo.com
MD, doctor of the Department of the Functional Diagnosis
Kristina A. Gladkova
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: k_gladkova@oparina4.ru
MD, senior researcher of the Department of Pregnancy Loss Prevention and Therapy
Nana K. Tetruashvili
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: tetrauly@mail.ru
Doctor of Medicine, Head of the Department of Pregnancy Loss Prevention and Therapy
References
- Baergen N.R. Manual of pathology of the human placenta. 2nd ed. Springer; 2011.
- Lewi L., Deprest J., Hecher K. The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. Am. J. Obstet. Gynecol. 2013; 208(1): 19-30. doi: 10.1016/j.ajog.2012.09.025.
- Низяева Н.В., Костюков К.В., Гладкова К.А., Куликова Г.В., Щеголев А.И. Роль синдрома обратной артериальной перфузии близнецов в развитии плода-акардиуса. Архив патологии. 2016; 78(4): 54-7.
- Костюков К.В., Павлов К.А., Дубова Е.А., Стыгар А.М., Гус А.И., Щеголев А.И. Синдром обратной артериальной перфузии (клинические наблюдения и обзор литературы). Медицинская визуализация. 2012; 6: 120-6.
- Кур мангали Ж.К., Джаманаева К.Б., Жулаушинова М.Е., Усеева М.С. Случай синдрома обратной артериальной перфузии с благоприятным исходом для ребенка. Акушерство и гинекология. 2014; 5: 84-6.
- Прибушеня О.В., Новикова И.В., Семенчук В.Л., Лазаревич А.А., Белуга М.В. Синдром обратной артериальной перфузии близнецов: медико-генетическое консультирование, акушерская тактика и методы коррекции. Пренатальная диагностика. 2015; 3: 215-23.
- Moore T.R., Gale S., Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990;163:907-12.
- Jelin E., Hirose S., Rand L., Curran P., Feldstein V., Guevara-Gallardo S. et al. Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Fetal Diagn. Ther. 2010; 27(3): 138-41. doi: 10.1159/000295176.
- Lewi L., Valencia C., Gonzalez E., Deprest J., Nicolaides K.H. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am. J. Obstet. Gynecol. 2010; 203:213. e1-4. doi: 10.1016/ j.ajog.2010.04.018.
- Scheier M., Molina F.S. Outcome of twin reversed arterial perfusion sequence following treatment with interstitial laser: a retrospective study. Fetal Diagn. Ther. 2012; 31(1): 35-41. doi: 10.1159/000334156.
- Pagani G., D’Antonio F., Khalil A., Papageorghiou A., Bhide A., Thilaganathan B. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis. Ultrasound Obstet. Gynecol. 2013; 42(1): 6-14. doi: 10.1002/uog.12495.
- Berg C., Holst D., Mallmann M.R., Gottschalk I., Gembruch U., Geipel A. Early vs late intervention in twin reversed arterial perfusion sequence. Ultrasound Obstet. Gynecol. 2014; 43(1): 60-4. doi: 10.1002/uog.12578.
- Hecher K., Lewi L., Gratacos E., Huber A., Ville Y., Deprest J. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet. Gynecol. 2006; 28(5): 688-91. doi: 10.1002/ uog.3816.
- Corbacioglu A., Gul A., Bakirci I.T., Gedikbasi A., Yildirim G. Treatment of twin reversed arterial perfusion sequence with alcohol ablation or bipolar cord coagulation. Int. J. Gynaecol. Obstet. 2012; 117(3): 257-9. doi: 10.1016/j. ijgo.2011.12.022.
- Takano M., Murata S., Fujiwara M., Hirata H., Nakata M. Experience of fetoscopic laser photocoagulation and cord transection for twin-reversed arterialperfusion sequence. J. Obstet. Gynaecol. Res. 2015; 41(9): 1326-9. doi: 10.1111/ jog.12720.
- Weichert A., Kalache K., Hein P., Brauer M., Hinkson L., Henrich W. Radiofrequency ablation as a minimally invasive procedure in the treatment of twin reversed arterial perfusion sequence in twin pregnancy. J. Clin. Ultrasound. 2013; 41(4): 245-7. doi: 10.1002/jcu.21932.
- Chaveeva P., Poon L.C., Sotiriadis A., Kosinski P., Nicolaides K.H. Optimal method and timing of intrauterine intervention in twin reversed arterial perfusion sequence: case study and meta-analysis. Fetal Diagn. Ther. 2014; 35(4): 267-79. doi: 10.1159/000358593.
- Абрамян М.А., Гладкова К.А., Костюков К.В., Тетруашвили Н.К. Открытая и пункционная хирургия плода в современном акушерстве. Акушерство и гинекология. 2014; 1: 3-8.
Supplementary files
