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Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence

https://doi.org/10.17749/2070-4909.2020.13.1.36-42

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Abstract

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. 

About the Authors

V. I. Tsibizova
Almazov National Medical Research Center
Russian Federation

Valentina I. Tsibizova – Doctor, Departments of Functional and Ultrasound Diagnostics

2 Akkuratova Str., St Petersburg 197341



I. E. Govorov
Almazov National Medical Research Center
Russian Federation

Igor E. Govorov – MD, PhD, Obstetrician-Gynecologist, Research Laboratory of Operative Gynecology

Scopus Author ID: 57188586021. Researcher ID: P-1257-2015

2 Akkuratova Str., St Petersburg 197341



I. I. Averkin
Almazov National Medical Research Center
Russian Federation

Igor I. Averkin – pediatric cardiologist, Department of Pediatric Cardiology

2 Akkuratova Str., St Petersburg 197341



N. M. Khamani
Sechenov University
Russian Federation

Nadin M. Khamani – Postgraduate student, Department of Obstetrics and Gynecology

8-2 Trubetskaya Str., Moscow 119048



D. V. Blinov
Institute of Preventive and Social Medicine ; Lapino Clinic Hospital, MD Medical Group
Russian Federation

Dmitry V. Blinov – MD, PhD, MBA, Head of Medical and Scientific Affairs; Neurologist

Researcher ID: E-8906-2017. RSCI: 9779-8290

4-10 Sadovaya-Triumfalnaya Str., Moscow 127006; 1st Uspenskoye Highway, 111, Moscow Region, Odintsovo District, Lapino



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For citation:


Tsibizova V.I., Govorov I.E., Averkin I.I., Khamani N.M., Blinov D.V. Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2020;13(1):36-42. (In Russ.) https://doi.org/10.17749/2070-4909.2020.13.1.36-42

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ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)