辅助生殖技术助孕后三胎合并双胎反向动脉灌注序列征一例并文献复习

doi:10.12280/gjszjk.20230208

摘要/Abstract

摘要：

双胎反向动脉灌注序列征（twin reversed arterial perfusion sequence，TRAPS）是单绒毛膜双胎妊娠（单绒双胎）的严重并发症，较为罕见，是由于双胎妊娠中胎儿胎盘间血管异常吻合所致，特征表现为其中一胎心脏缺如或心脏结构失去正常发育形态。报告南通大学附属南通妇幼保健院收治的1例发生于辅助生殖技术助孕后三胎妊娠中的TRAPS。患者移植2枚卵裂期冻融胚胎，其中1枚胚胎在分裂过程中发育为单绒双胎。患者孕8⁺⁵周早孕B超及时诊断单绒双胎为TRAPS，但因个人因素未行干预，单绒双胎TRAPS之泵血胎儿死亡。另一单胎发育正常至足月分娩。TRAPS如果需要治疗，射频消融术通常是阻断无心胎儿血流供应技术的首选方法，但干预的最佳时机仍存在争议。

关键词: 生殖技术, 辅助, 双胎, 单卵, 妊娠, 三胎, 双胎反向动脉灌注序列征, 诊断, 治疗

Abstract:

Twin reversed arterial perfusion sequence (TRAPS) is a rare and severe complication of monochorionic twin pregnancies, due to abnormal placental-fetal vascular anastomosis, which is characterized by absence of heart or loss of normal cardiac structure in one twin. We reported a case of triplet pregnancy complicated by TRAPS after assisted reproductive technology. Two cleavage-stage frozen embryos were transferred, one of which developed into monochorionic twin pregnology. The TRAPS was diagnosed by ultrasound at 8⁺⁵ weeks. However, due to personal factors, the patient did not intervene in a timely manner and the pump twin died. Another single fetus developed normally until full term delivery. If the treatment is needed, as for the technique of choice to interrupt the vascular supply to the acardiac twin, the radiofrequency ablation of the intrafetal vessel is usually the preferred approach. However, the best timing of intervention is still debated.

Key words: Reproductive techniques, assisted, Twins, monozygotic, Pregnancy, triplet, Twin reversed arterial perfusion sequence, Diagnosis, Therapy

李婷婷, 谭小方, 施蔚虹. 辅助生殖技术助孕后三胎合并双胎反向动脉灌注序列征一例并文献复习[J]. 国际生殖健康/计划生育杂志, 2024, 43(1): 24-27.

LI Ting-ting, TAN Xiao-fang, SHI Wei-hong. Triplet Pregnancy Complicated by Twin Reversed Arterial Perfusion Sequence after Assisted Reproductive Technology: A Case Report and Literature Review[J]. Journal of International Reproductive Health/Family Planning, 2024, 43(1): 24-27.

图/表 1

参考文献 23

[1]	Hans P. Twin Reversed Arterial Perfusion[J]. Cureus, 2022, 14(11):e31116. doi: 10.7759/cureus.31116.
[2]	van Gemert MJ, van den Wijngaard JP, Vandenbussche FP. Twin reversed arterial perfusion sequence is more common than generally accepted[J]. Birth Defects Res A Clin Mol Teratol, 2015, 103(7):641-643. doi: 10.1002/bdra.23405.
[3]	Imaizumi Y. A comparative study of zygotic twinning and triplet rates in eight countries, 1972-1999[J]. J Biosoc Sci, 2003, 35(2):287-302. doi: 10.1017/s0021932003002876. pmid: 12664963
[4]	杨小红, 陈欣林, 杨菁. 产前超声在双胎反向动脉灌注序列征胎儿诊断中的临床应用[J]. 中华医学超声杂志(电子版), 2014, 11(7):552-556. doi: 10.3877/cma.j.issn.1672-6448.2014.07.007.
[5]	Dhanju G, Breddam A. Twin reversed arterial perfusion (TRAP) sequence: A case report and a brief literature review[J]. Radiol Case Rep, 2022, 17(5):1682-1691. doi: 10.1016/j.radcr.2022.02.057.
[6]	Dubey S, Verma M, Goel P, et al. Twin Reversed Arterial Perfusion: To Treat or Not?[J]. J Clin Diagn Res, 2017, 11(1):QD05-QD07. doi: 10.7860/JCDR/2017/24400.9140.
[7]	Guimaraes CV, Kline-Fath BM, Linam LE, et al. MRI findings in multifetal pregnancies complicated by twin reversed arterial perfusion sequence (TRAP)[J]. Pediatr Radiol, 2011, 41(6):694-701. doi: 10.1007/s00247-010-1921-2. pmid: 21174084
[8]	Singh P, Bansal S, Ghuman N, et al. Fetus Acardiac Amorphous Presenting as Placental Tumor: A Rare Case and Differentiating the Two[J]. J Med Ultrasound, 2021, 29(4):281-283. doi: 10.4103/JMU.JMU_131_20. pmid: 35127409
[9]	Wong AE, Sepulveda W. Acardiac anomaly: current issues in prenatal assessment and treatment[J]. Prenat Diagn, 2005, 25(9):796-806. doi: 10.1002/pd.1269.
[10]	Yıldırım E. Spontaneous triplet pregnancy and trap sequence, case report[J]. BMC Pregnancy Childbirth, 2019, 19(1):328. doi: 10.1186/s12884-019-2484-3.
[11]	McCurdy CM Jr, Childers JM, Seeds JW. Ligation of the umbilical cord of an acardiac-acephalus twin with an endoscopic intrauterine technique[J]. Obstet Gynecol, 1993, 82(4 Pt 2 Suppl):708-711. pmid: 8378022
[12]	Hecher K, Lewi L, Gratacos E, et al. Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord[J]. Ultrasound Obstet Gynecol, 2006, 28(5):688-691. doi: 10.1002/uog.3816.
[13]	Seshadri S, Shinde RR, Ram U. Intrafetal laser for midtrimester TRAP sequence-experience from a single center[J]. Prenat Diagn, 2020, 40(7):885-891. doi: 10.1002/pd.5707.
[14]	Sago H, Wada S. Fetal therapies as standard prenatal care in Japan[J]. Obstet Gynecol Sci, 2020, 63(2):108-116. doi: 10.5468/ogs.2020.63.2.108. pmid: 32206649
[15]	Cabassa P, Fichera A, Prefumo F, et al. The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 166(2):127-132. doi: 10.1016/j.ejogrb.2012.10.009. pmid: 23122031
[16]	Lee H, Bebbington M, Crombleholme TM, et al. The North American Fetal Therapy Network Registry data on outcomes of radiofrequency ablation for twin-reversed arterial perfusion sequence[J]. Fetal Diagn Ther, 2013, 33(4):224-229. doi: 10.1159/000343223. pmid: 23594603
[17]	Kohei S, Kiyotake I, Takashi O, et al. Twin-Reversed Arterial Perfusion Sequence Using High-Intensity Focused Ultrasound Therapy: HIFU and TRAP[J]. Ultrasound Obstet Gynecol, 2018, 54(1):128-134. doi: 10.1002/uog.20101.
[18]	Lewi L, Valencia C, Gonzalez E, et al. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester[J]. Am J Obstet Gynecol, 2010, 203(3):213.e1-e4. doi: 10.1016/j.ajog.2010.04.018.
[19]	Pagani G, D′Antonio F, Khalil A, et al. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis[J]. Ultrasound Obstet Gynecol, 2013, 42(1):6-14. doi: 10.1002/uog.12495. pmid: 23640771
[20]	Tavares de Sousa M, Glosemeyer P, Diemert A, et al. First-trimester intervention in twin reversed arterial perfusion sequence[J]. Ultrasound Obstet Gynecol, 2020, 55(1):47-49. doi: 10.1002/uog.20860. pmid: 31486133
[21]	Roethlisberger M, Strizek B, Gottschalk I, et al. First-trimester intervention in twin reversed arterial perfusion sequence: does size matter?[J]. Ultrasound Obstet Gynecol, 2017, 50(1):40-44. doi: 10.1002/uog.16013. pmid: 27390925
[22]	Tang Y, Zeng Y, Yang T, et al. Ultrasound Assessment of Twin Reversed Arterial Perfusion Sequence for the Prediction of Adverse Pregnancy Outcomes in the First Trimester[J]. J Evid Based Med, 2022, 15:230-235. doi: 10.21203/rs.3.rs-142998/v1.
[23]	孙贻娟, 黄国宁, 孙海翔, 等. 关于胚胎移植数目的中国专家共识[J]. 生殖医学杂志, 2018, 27(10):940-945. doi: 10.3969/j.issn.1004-3845.2018.10.003.