scholarly journals EP20.05: A case of twin reversed arterial perfusion (TRAP) sequence misdiagnosed as discordant twin in first trimester

2017 ◽  
Vol 50 ◽  
pp. 352-352
Author(s):  
J. Kim ◽  
Y. Kim
Keyword(s):  
First Trimester ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Discordant Twin

Intrafetal Laser Coagulation for Trap Sequence in a Complicated Dichorionic Triamniotic Triplet Pregnancy Case Report and Review of the Literature

2017 ◽  
Vol 10 (2) ◽  
pp. 146-150
Author(s):  
Petya P. Chaveeva ◽  
Slavcho T. Tomov ◽  
Atanas D. Shterev
Keyword(s):  
Pregnancy Outcome ◽  
Color Doppler ◽  
First Trimester ◽  
Laser Coagulation ◽  
Triplet Pregnancy ◽  
Vitro Fertilization ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion

Summary A rare case is reported of twin-reversed arterial perfusion (TRAP) sequence in a triplet pregnancy, fetal intervention in the first trimester and pregnancy outcome. We report a case of TRAP sequence complication in dichorionic triamniotic triplet pregnancy, with a normally developing fetus and an acardiac fetus connected via arterio-arterial anastomoses in a monochorionic diamniotic twin pair and a separate fetus. TRAP sequence was diagnosed at 13 weeks in triplet pregnancy after in vitro fertilization (IVF) and embryo transfer of two blastocysts. Color Doppler assessment showed persistent arterial flow in the acardiac twin. Intrafetal laser coagulation was carried out at the time of the diagnosis, and the pregnancy outcome was two survivals at 36.4 weeks of gestation.

Prenatal surgery in a triplet pregnancy complicated by a double twin reversed arterial perfusion (TRAP) sequence

2012 ◽  
Vol 1 (1-2) ◽  
Author(s):  
Maria-Elisabeth Smet ◽  
Dirk Smet ◽  
Philip DeKoninck ◽  
Luc De Catte ◽  
Jan Deprest ◽  
...  
Keyword(s):  
Normal Growth ◽  
First Trimester ◽  
Baby Girl ◽  
Triplet Pregnancy ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
First Case ◽  
Umbilical Cords ◽  
Twin Reversed Arterial Perfusion ◽  
Double Twin

AbstractTo the best of our knowledge, we report the first case of a successful antenatal intervention in a double twin reversed arterial perfusion (TRAP) sequence in a monoamniotic monochorial triplet pregnancy. After diagnosis during first-trimester ultrasound, fetoscopic coagulation and transection of the umbilical cords of both acardiac members was performed at 16 weeks of gestation. The immediate postoperative course was complicated with iatrogenic preterm premature rupture of membranes, which was successfully reversed with an amniopatch procedure. Consequent sonographic assessments showed a healthy fetus with normal growth and development, together with progressive atrophy of the acardiac fetuses. Owing to placental abruption, an urgent cesarean section was performed at 32 weeks. A baby girl of 1600 g was born in good general condition. Except for the butts of the transected umbilical cords, there were no remnants of the TRAP twins to be distinguished. After a neonatal follow up of 64 days, the baby girl could be discharged.

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

2021 ◽  
pp. 1-7
Author(s):  
Eva Christin Weber ◽  
Florian Recker ◽  
Ingo Gottschalk ◽  
Brigitte Strizek ◽  
Annegret Geipel ◽  
...  
Keyword(s):  
Expectant Management ◽  
First Trimester ◽  
Bleeding Complications ◽  
Intrauterine Death ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Management Group ◽  
Group A ◽  
Group B ◽  
Twin Reversed Arterial Perfusion

<b><i>Introduction:</i></b> The aim of this study is to evaluate the outcome of pregnancies complicated by monochorionic monoamniotic twin reversed arterial perfusion sequence (MOMA TRAP) diagnosed in the first trimester. <b><i>Methods:</i></b> All patients diagnosed with MOMA TRAP sequence &#x3c;14.0 weeks of gestation in a 10-year study period were retrospectively analyzed for intrauterine course and outcome. All patients were offered either expectant management or intrauterine intervention. Adverse outcome was defined as either intrauterine death (IUD), neonatal death or preterm birth &#x3c;34.0 weeks of gestation. <b><i>Results:</i></b> In the study period, 17 cases with MOMA TRAP sequence were diagnosed. Of these, 2 couples opted for termination of pregnancy. The remaining 15 were divided into 2 groups depending on the management: group A (<i>n</i> = 8) with expectant management and group B (<i>n</i> = 7) with intrauterine intervention. All fetuses in group A died before 20 weeks. Survival in group B was significantly better with 4/7 (57.1%) life births at a median of 39.6 weeks of gestation (<i>p</i> = 0.0256). The reasons for IUD in the 3 cases in group B were hemodynamic, strangulation, and bleeding complications during intervention. <b><i>Conclusions:</i></b> Intrauterine intervention in MOMA TRAP pregnancies significantly improves neonatal survival, although it is still associated with a substantial risk for IUD by hemodynamic complications or entanglement.

scholarly journals Ultrasound Assessment of Twin Reversed Arterial Perfusion Sequence for the Prediction of Adverse Pregnancy Outcomes in the First Trimester

2021 ◽  
Author(s):  
Ying Tang ◽  
Yan Zeng ◽  
Taizhu Yang ◽  
Pan Yang ◽  
Shan Bao ◽  
...  
Keyword(s):  
Gestational Age ◽  
Pregnancy Outcomes ◽  
First Trimester ◽  
Adverse Pregnancy Outcomes ◽  
University Hospital ◽  
Intrauterine Death ◽  
Crown Rump Length ◽  
Arterial Perfusion ◽  
Adverse Pregnancy ◽  
Twin Reversed Arterial Perfusion

Abstract ObjectivesTo investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14 weeks. MethodsPregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin’s crown-rump length (CRL) and acardiac twin’s upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL-URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. ResultsTwenty-one pregnant women aged 21–39 years with a gestation of 11-14 weeks were recruited. TRAP was diagnosed on average (± standard deviation [SD]) at pregnancy week 13.1 ± 0.18. The pump twins’ mean (± SD) CRL was 6.65 ± 1.1 cm. The incidence of intrauterine death for the pump twins was 19.0% (n=4), the miscarriage rate was 14.3% (n=3), and the live birth rate was 66.7% (n=14). The (CRL-URL)/CRL ratios between the non-survival (intrauterine death and miscarriage) and survival groups significantly differed (0.33 ± 0.08 vs. 0.58 ± 0.08, p < 0.05). Similarly, the URL/CRL ratios between the non-survival and survival groups significantly differed (0.67 ± 0.08 vs. 0.42 ± 0.08, p < 0.05). ConclusionsThe (CRL-URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.

Twin-Reversed Arterial Perfusion Sequence in a Triple Monochorionic Pregnancy with Two Direct Pump Fetuses Results in Significant Cyclic Doppler Waveform

2014 ◽  
Vol 37 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Rocío López-Pérez ◽  
Mónica Lorente ◽  
Juan Martínez-Uriarte ◽  
Inmaculada M. Rivero ◽  
Olivia García-Izquierdo ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Doppler Ultrasound ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Doppler Waveform ◽  
Waveform Pattern ◽  
Direct Pump ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

We report a case of a twin-reversed arterial perfusion (TRAP) sequence complication in monochorionic triplets, in which both normal fetuses were directly connected to the umbilical cord of the acardiac fetus, thus both acting as a pump twin. Doppler ultrasound showed a significant waveform pattern with two superposed systolic waveforms in the same vessel. After birth, placental findings confirmed the existence of two direct pump twins. The Doppler pattern described here may be of help to distinguish the existence of two pump twins in a triplet monochorionic pregnancy with TRAP.

Twin reversed arterial perfusion (TRAP) sequence managed at 11+6 weeks with radiofrequency ablation

2014 ◽  
Vol 3 (2) ◽  
Author(s):  
Gwangjun Kim ◽  
Min Young Park ◽  
Seung Su Han
Keyword(s):  
Case Report ◽  
Radiofrequency Ablation ◽  
Gestational Age ◽  
Feeding Artery ◽  
First Line ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Line Management

AbstractRadiofrequency ablation (RFA) has become widely accepted as first-line management for twin reversed arterial perfusion (TRAP) sequence. Most RFA procedures have been performed using RFA needles of 14–17 gauge (G) focusing on an acardiac mass at an average age of 21 weeks of gestation (17–24 weeks). In this case report, we describe treatment of TRAP sequence using RFA with a 20 G needle focusing a feeding artery on the placental surface at gestational age of 11+6.

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