Twin Reverse Arterial Perfusion (TRAP): Case Report

Abstract

The twin reversed arterial perfusion (TRAP) sequence is an anomaly unique to monochorionic multiple pregnancies. It is a rare complication. We present a case of acardius anephus, which was mistaken for a live anomalous singleton fetus. A 21-year-old unbooked Primigravida was seen in labour ward with a ten hours history of labour pains. Urgent transabdominal ultrasound revealed a singleton live fetus at 30 weeks gestation with gross cystic mass lesion at the level of the abdomen and polyhydramnious. Caesarean section confirms a twin gestation with monoamniotic monochorionic single placenta. The umbilical cord of the acardiac twin was short-First twin was a live female baby, weighing 1000 g. TRAP is a rare event an early referral to feto maternal unit will improve perinatal outcome.

Twin reverse arterial perfusion sequence: A case report and literature review

“…A pathognomic finding is the demonstration at colour Doppler of a paradoxical circulation in the acardiac twin, with arterial blood flowing towards rather than away and a caudal to cranial course in the abdominal aorta (even evident during the first trimester) [7]. Langlotz et al, suggested this peculiar Doppler findings of reverse anastomosis in the first case of TRAPS.…”

“…These featured were seen in the foetus. There might be marked oedema and cystic changes in the upper body [7,13].…”

“…As a result, the perfused twin-the parasite receives the deoxygenated arterial blood from the pump twin leading to a complete acardia (holocardiac) or rudimentary non-functional heart (hemicardiac) [1]. TRAPS is a rare complication affecting 1% of monochorionic twin pregnancy [6] and [1] of 35000 pregnancies [7,8]. However, with the spread of assisted reproductive technology and improved diagnostic ultrasonography, the incidence of TRAPS is increasing towards 2.6% of monozygotic twins and [1] of 9500 to 11000 pregnancies [9,10].…”

“…The ultrasound finding suggestive of TRAPS is the demonstration at colour Doppler of a paradoxical circulation in the acardiac twin with arterial blood flowing towards rather than away and a caudal to cranial course in the abdominal aorta [7]. Early diagnosis and intervention could savage 85% of cases, but with a late diagnosis, a substantial proportion die in utero at about 18 weeks of gestation and about 55% are lost in later gestational age or early neonatal period [1].…”

Case report-fetal major anomaly-human cyclops fetus acardia

“…The Etiopathogenesis of acardiac anomaly is explained by the presence of an arterio-arterial anastomosis or by organ dysmorphogenesis [2] Cardiac dysmorphogenesis is developmental defect in organogenesis, a "cardiac regression sequence". The arterio-arterial anastomosis is characterized by the reversed blood flow from umbilical artery of the pump twin into the umbilical artery of the perfused twin due to sharing of a common placenta and abnormal placental vascular anastomoses between thetwins [3,4] . The pump twin is at risk of development of cardiac failure, intra uterine growth retardation, polyhydramnios or even Intra uterine death due to reversal of flow.…”