Abstract

Background: Twin reversed arterial perfusion (TRAP) sequence is a high-risk condition in monochorionic twin pregnancies, in which adverse outcomes of the pump twin are closely related to the duration and magnitude of abnormal perfusion. Early treatment with minimally invasive fetal techniques may reduce procedure-related morbidity and improve pregnancy outcomes. Objective: In this case report, we describe the first successful application of early fetal radiofrequency ablation at 16 weeks of gestation for the treatment of TRAP sequence in Vietnam. This report emphasizes the rationale for early intervention, the minimally invasive nature of the procedure, and the favorable clinical outcome, contributing practical insights to contemporary fetal therapy practice. Case presentation: We report a case of monochorionic twin pregnancy complicated by twin reversed arterial perfusion (TRAP) sequence, diagnosed and treated at 16 weeks of gestation. Ultrasound and Doppler examination demonstrated persistent reversed arterial perfusion to the acardiac twin without evidence of progressive cardiac failure in the pump twin. Given the early gestational age and the short distance between the umbilical cord insertion of the acardiac twin and the pump twin (approximately 1 cm), intrafetal radiofrequency ablation was performed under continuous ultrasound guidance to occlude the blood supply to the acardiac twin. The procedure was successfully completed with a single percutaneous entry, resulting in immediate cessation of reversed perfusion. No procedure-related complications, including membrane rupture or preterm birth, were observed during follow-up. The patient was managed on an outpatient basis thereafter, and the pregnancy was completed at 37 weeks of gestation with the delivery of a male neonate weighing 2600gram, with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. Conclusion: Early fetal radiofrequency ablation at 16 weeks of gestation is a feasible and minimally invasive treatment option for TRAP sequence. This first reported Vietnamese case highlights the potential benefits of early intervention in reducing invasiveness and procedure-related risks while achieving favorable perinatal outcomes.

Key words: Twin reversed arterial perfusion, Acardiac twin, Pump twin, Radiofrequency, Ablation.