Diagnosis of twin reversed arterial perfusion sequence in the first trimester by transvaginal color Doppler ultrasound

Abstract

A case of twin reversed arterial perfusion (TRAP) sequence was diagnosed at 12 weeks' gestation using transvaginal color Doppler ultrasound, which demonstrated the presence of retrograde perfusion in the umbilical artery of the abnormal twin. Ultrasound imaging showed a monochorionic-diamniotic twin pregnancy with an inappropriately grown second twin, the morphological evaluation of which revealed an abnormal cephalic pole with acrania, diffuse subcutaneous edema and the presence of cardiac activity in an abnormal heart with a single chamber.

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

“…The diagnosis can be reliably made on ultrasound scan in the first-trimester. 3 TRAP sequence is characterized by a grossly abnormal fetus that grows, may even show movements, but has no functional cardiac activity of its own. Rarely, a rudimentary heart may show pulsatility.…”

Vanishing Twin: A Possible Cause of Cerebral Impairment

“…In second and third trimesters such anastomoses were noted to result in hemodynamic instability leading to fetal death or ischemic cerebral damage in either or both twins. Twin reversed arterial perfusion (TRAP) has been demonstrated as early as 12 weeks suggesting that these anastomoses are functional from very early in gestation (Kamitomo et al, 2004;Schwarzler et al, 1999). However, the precise timing of when the anastomoses become functional is unclear.…”

Delayed Structural Development in an Acardiac Fetus: An Echographic Observation

“…Only a few cases of early detection (late first trimester) of the TRAP sequence have been published up until now [5][6][7][8][9][10][11] . In our case the diagnosis was suspected at 11 weeks and 4 days by the appearance of a mass with positive Doppler flow, next to the presumed single pregnancy.…”