Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence
Introduction. Twin reversed arterial perfusion (TRAP) syndrome is one of the types of complications of monochorial twins (MT) with a frequency of occurrence of 1:35000 births. It is characterized by the presence of the main vessel instead of a normal 4 chambers heart and intrauterine developmental a...
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IRBIS LLC
2020-04-01
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| Series: | Фармакоэкономика |
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| Online Access: | https://www.pharmacoeconomics.ru/jour/article/view/340 |
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| author | V. I. Tsibizova I. E. Govorov I. I. Averkin N. M. Khamani D. V. Blinov |
| author_facet | V. I. Tsibizova I. E. Govorov I. I. Averkin N. M. Khamani D. V. Blinov |
| author_sort | V. I. Tsibizova |
| collection | DOAJ |
| description | Introduction. Twin reversed arterial perfusion (TRAP) syndrome is one of the types of complications of monochorial twins (MT) with a frequency of occurrence of 1:35000 births. It is characterized by the presence of the main vessel instead of a normal 4 chambers heart and intrauterine developmental abnormalities. This pregnancy requires monitoring using dynamic ultrasound diagnostics every 7 days, in accordance with current recommendations. The treatment is intrauterine laser coagulation of blood vessels of the “acardial fetus” (AP) in order to prevent the development of a threatening condition for the “fetal pump” (PP). Aim: to demonstrate the possibilities of comprehensive conservative management of monochorial pregnancy complicated by TRAP.Materials and methods. An ultrasound examinations were performed on a weekly basis in monochorionic pregnancy, complicated by TRAP within the period 12-38 weeks. Serum concentrations of biochemical markers PAPP-A (pregnancy-associated plasma protein-A) and β-hGC (β-subunit of human chorionic gonadotropin) were studied in the first trimester to predict adverse perinatal outcomes.Results. The possibility of prolonging a pregnancy complicated by TRAP without performing intrauterine surgical intervention, during which quite serious complications can occur in this category of pregnancies, has been demonstrated. In a patient with monochorionic twins complicated by TRAP, totally 27 ultrasound examinations were performed within the period 12-38 weeks. This approach made it possible to dynamically monitor the condition of a pregnant and healthy fetus and to prolong pregnancy without surgery until the full term.Conclusions. Following the existing guidelines, without tailoring for individual risk, may lead to an unreasonable increase in surgical interventions. In turn, surgery is not only accompanied by a high risk of complications (up to 15%), but also constitute a certain financial burden on the budget, determined by the state on the level of 208,000 rubles. Performing routine ultrasound examinations according to the examination protocol for monochorionic pregnancy will contribute to avoiding the complications associated with surgery and better selection for surgery as well as reducing the government costs. |
| format | Article |
| id | doaj-art-490765eb67944fdd908c5b84d2f85bfc |
| institution | DOAJ |
| issn | 2070-4909 2070-4933 |
| language | Russian |
| publishDate | 2020-04-01 |
| publisher | IRBIS LLC |
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| series | Фармакоэкономика |
| spelling | doaj-art-490765eb67944fdd908c5b84d2f85bfc2025-08-20T03:19:20ZrusIRBIS LLCФармакоэкономика2070-49092070-49332020-04-01131364210.17749/2070-4909.2020.13.1.36-42287Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequenceV. I. Tsibizova0I. E. Govorov1I. I. Averkin2N. M. Khamani3D. V. Blinov4Almazov National Medical Research CenterAlmazov National Medical Research CenterAlmazov National Medical Research CenterSechenov UniversityInstitute of Preventive and Social Medicine ; Lapino Clinic Hospital, MD Medical GroupIntroduction. Twin reversed arterial perfusion (TRAP) syndrome is one of the types of complications of monochorial twins (MT) with a frequency of occurrence of 1:35000 births. It is characterized by the presence of the main vessel instead of a normal 4 chambers heart and intrauterine developmental abnormalities. This pregnancy requires monitoring using dynamic ultrasound diagnostics every 7 days, in accordance with current recommendations. The treatment is intrauterine laser coagulation of blood vessels of the “acardial fetus” (AP) in order to prevent the development of a threatening condition for the “fetal pump” (PP). Aim: to demonstrate the possibilities of comprehensive conservative management of monochorial pregnancy complicated by TRAP.Materials and methods. An ultrasound examinations were performed on a weekly basis in monochorionic pregnancy, complicated by TRAP within the period 12-38 weeks. Serum concentrations of biochemical markers PAPP-A (pregnancy-associated plasma protein-A) and β-hGC (β-subunit of human chorionic gonadotropin) were studied in the first trimester to predict adverse perinatal outcomes.Results. The possibility of prolonging a pregnancy complicated by TRAP without performing intrauterine surgical intervention, during which quite serious complications can occur in this category of pregnancies, has been demonstrated. In a patient with monochorionic twins complicated by TRAP, totally 27 ultrasound examinations were performed within the period 12-38 weeks. This approach made it possible to dynamically monitor the condition of a pregnant and healthy fetus and to prolong pregnancy without surgery until the full term.Conclusions. Following the existing guidelines, without tailoring for individual risk, may lead to an unreasonable increase in surgical interventions. In turn, surgery is not only accompanied by a high risk of complications (up to 15%), but also constitute a certain financial burden on the budget, determined by the state on the level of 208,000 rubles. Performing routine ultrasound examinations according to the examination protocol for monochorionic pregnancy will contribute to avoiding the complications associated with surgery and better selection for surgery as well as reducing the government costs.https://www.pharmacoeconomics.ru/jour/article/view/340multiply pregnancyfirst trimester screeningpregnancy associated plasma-apapp-abeta – human chorionic gonadotropinβ-hgcbiochemistry screeningtwinsacardius fetustraps |
| spellingShingle | V. I. Tsibizova I. E. Govorov I. I. Averkin N. M. Khamani D. V. Blinov Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence Фармакоэкономика multiply pregnancy first trimester screening pregnancy associated plasma-a papp-a beta – human chorionic gonadotropin β-hgc biochemistry screening twins acardius fetus traps |
| title | Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence |
| title_full | Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence |
| title_fullStr | Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence |
| title_full_unstemmed | Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence |
| title_short | Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence |
| title_sort | health technology assessment in obstetrics advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by trap sequence |
| topic | multiply pregnancy first trimester screening pregnancy associated plasma-a papp-a beta – human chorionic gonadotropin β-hgc biochemistry screening twins acardius fetus traps |
| url | https://www.pharmacoeconomics.ru/jour/article/view/340 |
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