UMBILICAL-CORD COAGULATION BY OPERATIVE MICROENDOSCOPY AT 16 WEEKS GESTATION IN AN ACARDIAC TWIN

Twin reversed arterial perfusion (TRAP) sequence carries high mortalit y and morbidity in the normal twin due to a hemodynamic imbalance thro ugh the fete-fetal vascular anastomosis. This report describes the ult rasound features of TRAP in the first trimester and a new technique fo r selective fetocide in the early second trimester in monochorionic tw in pregnancies complicated by the TRAP sequence. Laser coagulation of the umbilical cord of the acardiac twin was performed under sonoendosc opic control. The blood flow in the umbilical cord of the acardiac twi n was successfully arrested and the survivor developed normally. TRAP sequence can be recognized in the first trimester and successfully arr ested by microendoscopic surgery.