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.
References
[1]
Liesbeth, L. and Deprest, J. (2006) Fetal Problems in Multiple Pregnancy. In: James, D.K., Steer, P.J., Weiner, C.P. and Gonic, B., Eds., High Risk Pregnancy Management Options, 3rd Edition, Elsevier Inc., Philadelphia, pp. 524-561.
[2]
Prasad, R.H., Prasad, T.R. and Kumar, K.D. (2012) TRAP Sequence—An Interesting Entity in Twins. Journal of Clinical Imaging Science, 2, 56. http://dx.doi.org/10.4103/2156-7514.100997
[3]
Chandramouly, M. and Namitha (2009) Case Series: TRAP Sequence. Indian Journal of Radiology and Imaging, 19, 81-83. http://dx.doi.org/10.4103/0971-3026.45352
[4]
Athita, C. and Densak, P. (2007) TRAP Sequence in an Acardiac Twin. Journal of the Medical Association of Thailand, 90, 819-822.
[5]
Tan, T.Y. and Supulveda, W. (2003) Acardiac Twin: Systematic Review of Minimally Invasive Treatment Modalities. Ultrasound in Obstetrics & Gynecology, 22, 409-419. http://dx.doi.org/10.1002/uog.224
[6]
Bornstein, E., Monteagudo, A., Schwartz, N. and Ilan, E.T. (2008) Detection of Twin Reversed Arterial Perfusion Sequence at the Time of First-Trimester Screening. Journal of Ultrasound in Medicine, 27, 1105-1109.
[7]
Zeev, B., Abdallah, W., Onit, S.G. and Brook, O.R. (2008) Triplet Gestation-Prevention, Risk and Management Dilemmas. The Open Women’s Journal, 2, 11-21.
[8]
Bavarian, Sadidi, S. and Hassanzadeh, P. (2007) Acardiac Parabiotic Twin: A Case Report. A Case of Acardiac Parabiotic Twin 252 Iran. J. Radiol., 4.
[9]
Pandey, K., Arya, S. and Kaitiyar, G. (2010) A Rare Case of Acardiac Acephalus Twin Pregnancy. Journal of Obstetrics and Gynaecology of India, 60, 75-76. http://dx.doi.org/10.1007/s13224-010-0003-6
[10]
Weisz, B., Peltz, R., Chayen, B., Oren, M., Zalel, Y., Achiron, R., et al. (2004) Tailored Management of Twin Arterial Perfusion (TRAP) Sequence. Ultrasound in Obstetrics & Gynecology, 23, 451-455. http://dx.doi.org/10.1002/uog.1040
[11]
Amy, E., Michael, W., Robert, H., Marc, J. and Robert, M. (2003) The Management of Acardiac Twins: A Conservative Approach. American Journal of Obstetrics and Gynecology, 189, 1310-1313.
http://dx.doi.org/10.1067/S0002-9378(03)00597-0
[12]
Richard, P. (2004) Percutaneous Ultrasonographically Guided Ablation of an Active Twin. American Journal of Obstetrics and Gynecology, 190, 572-574.
[13]
Sepulveda, W., Sfeir, D., Reyes, M. and Martinez, J. (2000) Severe Polyhydramnios in Twin Reversed Arterial Perfusion Sequence: Successful Management with Intrafetal Alcohol Ablation of Acardiac Twin and Amniodrainage. Ultrasound in Obstetrics & Gynecology, 16, 260-263. http://dx.doi.org/10.1046/j.1469-0705.2000.00212.x
[14]
Kuojen, T., Vickie, A., Graig, T., Per, L., Hanmin, L., Michael, R., et al. (2002) Selective Reduction of Acardiac Twin by Radiofrequency Ablation. American Journal of Obstetrics and Gynecology, 187, 635-640.
http://dx.doi.org/10.1067/mob.2002.125242
[15]
Okai, T., Ichizuka, K., Hasegawa, J., Matsuoka, R., Nakamura, M., shimodaira, K., et al. (2013) First Successful Case of Non-Invaasive In-Utero Treatment of Twin Reversed Arterial Perfusion Sequence by High-Intensity Focused Ultrasound. Ultrasound in Obstetrics & Gynecology, 42, 112-114. http://dx.doi.org/10.1002/uog.12466
[16]
Marieke, H., Toon, T. and Yves, J. (2014) Late Presentation of Acardiac Twin: A Case Report and Review of Literature. OJOG, 4, 379-382. http://dx.doi.org/10.4236/ojog.2014.47056
[17]
Hecher, K., Lewi, L., Gratacos, E., Huber, A., Villes, Y. and Deprest, J. (2006) Twin Reversed Arterial Perfusion: Fetoscopic Laser Coagulation of Placental Anastomoses or the Umbilical Cord. Ultrasound in Obstetrics & Gynecology, 28, 688-691. http://dx.doi.org/10.1002/uog.3816
[18]
Pagani, G., D’Antonio, F., Khalil, A., Papageorghiou, A. and Bhide, A. (2013) Intrafetal Laser Treatment for Twin Reversed Arterial Perfusion Sequence: Cohort Study and Meta-Analysis. Ultrasound in Obstetrics & Gynecology, 42, 6-14.
