A rare complication of monochorionic twin pregnancy: Twin-reversed arterial perfusion (TRAP) sequence

Bharadwaj, Meenakshi K.; Priya, N. Mohana

doi:10.1016/j.mjafi.2013.06.008

Cited by 8 publications

(10 citation statements)

References 7 publications

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“…Mohamad H et al Int J Reprod Contracept Obstet Gynecol. 2023 Oct;12 (10):3181-3184 labor in women with twin pregnancies and a prior cesarean section had a shorter hospital stay and that there were no differences in maternal morbidity between births by trials of labor and by elective cesarean section. 17 Induction of labor was then performed according to the FIGO recommendations for misoprostol administration in case of fetal death.…”

Section: Discussionmentioning

confidence: 98%

“…Intrauterine fetal demise of a morphologically abnormal twin resembles an acardiac fetus, and hence ultrasonography plays an important role in differentiating TRAP sequence from intrauterine fetal demise. 10 The ultrasonographic findings of continued fetal growth and persistent intra-fetal blood flow raise the suspicion of TRAP sequence over fetal demise. 1 The optimal management of an acardiac twin pregnancy is still debated as it is rarely encountered.…”

Section: Discussionmentioning

confidence: 99%

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Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

Mohamad,

Barakat,

Hajjar

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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Twin reversed arterial perfusion (TRAP) sequence results from aberrant and asymmetrical twinning. It is a rare but serious complication of monozygotic twin pregnancies. It is characterized by a normally formed fetus that shows features of heart failure, and an acardiac twin. A 26-year-old pregnant woman, gravida 6, para 5, with mono-chorionic di-amniotic twin pregnancy at her 20th week of gestation, was diagnosed with TRAP sequence. Both the pump twin and the acardiac co-twin did not display any cardiac activity. Termination of pregnancy was accomplished by a successful vaginal birth after cesarean section (VBAC) following five prior cesarean sections. Proper and early diagnosis of TRAP sequence can aid in treatment selection and pump twin salvage. Induction of labor by both misoprostol and intracervical balloon catheter showed to be safe and effective in a woman with a uterine scar resulting from five prior cesarean sections.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

Mohamad,

Barakat,

Hajjar

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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“…In this situation, the preferred therapy, according to the previously described methods, is to block the blood supply to the malformed fetus from the donor fetus via umbilical cord ligation, occlusion by fetoscopic surgery, or radiofrequency ablation. [ 12 ] However, these methods were contraindicated due to the clinical characteristics (polyhydramnios, uterine contractions, and anterior placenta) of the 2 cases. Therefore, we injected 15 mL of 10% NaCl into the Wharton jelly of the umbilical cord of the malformed fetus.…”

Section: Discussionmentioning

confidence: 99%

A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery

Wu²,

Zhang³

2017

Medicine

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Rationale:The preferred method for multifetal pregnancy reduction (MFPR) is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). However, in monochorionic multiple pregnancies (MMPs), especially in monoamnionic multifetal pregnancies, selective feticide by this method is often associated with miscarriage of the remaining fetuses. Selective fetal reduction in MMPs by blood flow ablation using radiofrequency ablation or fetoscopic laser surgery may improve survival of the remaining fetus. Although often successful, MFPR by these methods is contraindicated in cases of twin reversed arterial perfusion (TRAP) sequence in triplet pregnancies complicated by polyhydramnios or anterior placenta, as it is difficult to locate the ablation target.Patient concerns:2 cases were admitted to Xiangya Hospital, Central South University with triplet pregnancies at 23 or 21weeks of gestation.Diagnoses:Case 1 was a 29-year-old woman with a triplet pregnancy in 2 distinct amniotic sacs and 1 fetus with multiple malformations. Case 2 was a 32-year-old woman who was identified as a triplet pregnancy with TRAP sequence with an acardiac/acephalic twin and anterior placenta.Interventions:Both of the 2 cases were underwent a new method for MFPR involving fine needle amniotic fluid aspiration and injection of hypertonic sodium chloride (10% NaCl) into the Wharton jelly of the umbilical cord.Outcomes:The 2 cases resulted in selective feticide and the birth of the remaining infants from the triplet pregnancies. All infants were healthy at birth and the 2-year follow-up.Lessons:The new approach provided a safer, more accessible, and more cost-effective method for MFPR in MMPs with a contraindication to fetoscopic surgery compared to radiofrequency ablation and fetoscopic laser surgery.

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“…A pesar del nombre arcádico es posible encontrar en algunos casos corazón. Spencer et al propusieron los criterios para diferenciar un feto acárdico de un teratoma: 1) el feto acárdico está contenido dentro del saco amniótico; 2) está cubierto por piel normal; 3) tiene partes anatómicas reconocibles, y 4) está unido a la placenta por un cordón umbilical acompañado de anastomosis vasculares ipsilaterales (43). El feto acárdico frecuentemente muestra columna vertebral bien desarrollada con costillas y una zona ósea identificable como base del cráneo.…”

Section: Discussionunclassified

Enfoque das gestações múltiplas de diagnóstico difícil durante a autopsia perinatal

et al. 2017

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Introducción: durante el examen de pediatría, genética, ecográfico o de anatomía patológica de fetos de gestaciones gemelares, suelen aparecer interrogantes en el diagnóstico diferencial, especialmente cuando los casos se asocian con maceración, malformaciones o duplicación de estructuras. Objetivo: proponer un algoritmo para el enfoque de la autopsia perinatal en gestaciones múltiples de difícil diagnóstico. Materiales y Métodos: estudio observacional descriptivo del universo de gestaciones gemelares vistas en el Departamento de Patología del Hospital Universitario San Ignacio (HUSI) entre 2007 y 2013. De nimos como “gestación múltiple de difícil diagnóstico” aquella en la que el examen del (de los) feto(s) planteó uno de los diagnósticos diferenciales: feto macerado/evanescente, gemelo siamés, fetus in fetu, feto acárdico o teratoma congénito. Se realizó el estudio anatomopatológico y junto con la literatura revisada, los gemelos se analizaron y clasificaron según el algoritmo propuesto. Resultados: hubo 59 casos de gestaciones gemelares en las que al menos uno de los fetos requirió autopsia perinatal. Las principales causas de muerte fueron las infecciones ascendentes seguidas del síndrome de transfusión feto-fetal. Como gestaciones múltiples de difícil diagnóstico observamos tres fetos acárdicos y ocho fetos macerados. Se aplicó el algoritmo propuesto en este artículo. Conclusiones: el diagnóstico en las gestaciones gemelares puede ser en ocasiones difícil. Identificamos los aspectos más importantes a tener en cuenta de la historia clínica y de la autopsia perinatal para llegar al diagnóstico definitivo. Desarrollamos un algoritmo para ser aplicado en estas circunstancias durante las autopsias perinatales.

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A rare complication of monochorionic twin pregnancy: Twin-reversed arterial perfusion (TRAP) sequence

Cited by 8 publications

References 7 publications

Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery

Enfoque das gestações múltiplas de diagnóstico difícil durante a autopsia perinatal

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