Objective:To investigate the natural history and perinatal outcomes of twin reverse arterial per-fusion (TRAP) sequence. Methods:A retrospective study was performed in 15 TRAP cases which underwent conservative management between July 2008 and December 2011. The pregnancy outcomes including preterm labor, abortion and average gestational age at delivery as well as the abdominal circumference (AC) ratio, umbilical artery pulsatile index (UA-PI) ratio of acardiac twin and pump twin were analyzed. 12-month follow-up was performed for the pump twin after birth. Results: Among the 15 TRAP cases, 11 cases were acardius acephaius, 4 cases were acardius anceps. 10 cases (67.7%) were misdiagnosed as intrauterine death(3 cases), edema (2 cases) and neck lymph aquatumor(5 cases)of one twin by first trimester ultra-sonography. For pump twin, 2 cases with potyhydramnios (1 case had induced abortion and 1 case had spontaneous abortion), 2 cases with fetal heart failure (1 case had preterm delivery and 1 case terminated pregnancy for congenital heart disease ) ,1 case with polyhydramnios as well as fetal heart failure had spontaneous abortion. For acardiac twin, 2 cases (13. 3%) had spontaneously stopped reversed arterial blood flow, among which 1 case had intrauterine fetal death at 37 gestational weeks, 1 case has stable ongoing pregnancy ; 8 cases (53. 3%) had rare blood flow( UA-PI ratio <0.7), among which 2 cases had spontaneous abortion, 1 case had induced abortion, 3 cases had three healthy infants after 1 year follow-up and 2 cases are in stable ongoing pregnancy; all other 5 cases (33.3%) with rich blood flow terminated pregnancy. Among 10 acardiac twin (66. 7%) with rapid growth (AC ratio >50%), 7 cases terminated pregnancy and 1 case had spontaneous abortion. Conclusions:Small acardiac twin and rare blood flow show less risk for the pump twin and better perinatal outcomes. The rapid growth of acardiac twin and the appearance of congestive heart failure of the pump twin or edema syndrome are suggested as poor prognostic factors.%目的:了解双胎反向动脉灌注序列症(TRAP序列症)的自然病程,分析其围生儿预后.方法:回顾性分析我院2008年7月至2011年12月收治的TRAP序列症15例患者的临床资料,对足月产、早产、流产及平均分娩孕周等资料进行统计,分析无心畸胎/供血儿的腹围比(AC比值)、脐动脉搏动指数(UA-PI)比、供血儿心脏情况等,并追踪供血儿出生后1年的健康状况.结果:15例TRAP序列症患者无心无头型11例,无心无脑型4例.10例孕早期超声检查误诊为双胎之一死亡(3例)、胎儿水肿(2例)和颈部淋巴水囊瘤(5例).供血儿情况:羊水过多2例(1例引产,1例自然流产)；心功能不全2例(1例因合并先天性心脏病引产,1例早产)；羊水过多合并心功能不全1例(自然流产).无心畸胎情况:无心畸胎血流自然阻断2例(13.3％),其中1例孕37周突发宫内死胎,1例继续妊娠(情况稳定)；无心畸胎血流微弱(UA-PI比值＜0.7)8例(53.3％),其中自然流产2例,引产1例,分娩活胎3例(追踪1年,3例新生儿均健康),继续妊娠2例(情况稳定)；无心畸胎血流丰富5例(33.3％)(均引产).另外无心畸胎出现迅速增长(AC比值＞50％)共10例(66.7％),其中引产7例,自然流产1例,仅2例剖官产分娩存活.结论:无心畸胎较小、血流不丰富者,自然病程良好.出现无心畸胎迅速生长、供血儿心力衰竭或水肿,提示胎儿死亡风险高或预后不良.
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