Acardius in a Triplet Pregnancy: Cytogenetic and Morphological Profile

1992 ◽  
Vol 41 (1) ◽  
pp. 27-32 ◽  
Author(s):  
I.I. Bolaji ◽  
G. Mortimer ◽  
F.P. Meehan ◽  
S. England ◽  
M. Greally
Keyword(s):  
Caesarean Section ◽  
Cytogenetic Analysis ◽  
Rare Case ◽  
Chromosomal Abnormalities ◽  
Triplet Pregnancy ◽  
Genetic Theory ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Structural Abnormalities ◽  
Twin Reversed Arterial Perfusion

AbstractWe describe a rare case of acardius in a triplet pregnancy terminated by Caesarean Section at 32 weeks gestation. Morphological and chromosomal abnormalities of the fetus as well as structural abnormalities of the placenta are presented. Cytogenetic analysis and examination of the single disc triplet placenta provide evidence for the two major theories of pathogenesis of acardius, the twin reversed arterial perfusion (TRAP) sequence and the genetic theory, which we believe are not necessarily mutually exclusive.

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.

scholarly journals Acardiac-acephalus Twinning- A Very Rare Case Report

2020 ◽  
Vol 32 (2) ◽  
pp. 143-144
Author(s):  
Parvez Ahmed ◽  
Nasrin Begum ◽  
Mostofa Shamim Ahsan ◽  
Mosharruf Hossain ◽  
Munshi Md Arif Hosen ◽  
...  
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Severe Form ◽  
Monochorionic Twin ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Rare Case Report ◽  
Medicine Today ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion

Introduction:This study highlights a very rare case which was related to abnormal monochorionic twinning status. Case Report: This case (a 28 year old pregnant woman) came at this institute for ultrasonographic evaluation of herpregnancy status. Her ultrasonographic results were consistent with acardiac-acephalus twinning condition (which isalso known as, twin reversed arterial perfusion or TRAP sequence). Discussion: This monochorionic twin pregnancy isa severe form of twin-to-twin transfusion syndrome (TTTS) and severe TTTS has mortality rate of about 60–100%. Conclusion: This case is very rare showing prevalence of about 1/35,000 overall pregnancies and accounting 1.0% ofthe monochorionic twin pregnancies. Medicine Today 2020 Vol.32(2): 143-144

scholarly journals A Case of Monochorionic-Triamniotic Triplet Pregnancy with TRAP Sequence Successfully Treated with Radiofrequency Ablation with a Parallel Circuit Consisting of Anastomosed Blood Vessels between the Direct Pump Fetus and the Indirect Pump Fetus

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Shusaku Kobori ◽  
Masatake Toshimitsu ◽  
Shinichi Nagaoka ◽  
Jun Murotsuki
Keyword(s):  
Radiofrequency Ablation ◽  
Blood Vessels ◽  
Multiple Pregnancy ◽  
Triplet Pregnancy ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Parallel Circuit ◽  
Twin Pregnancies ◽  
Direct Pump ◽  
Twin Reversed Arterial Perfusion

Monochorionic-triamniotic triplet pregnancy with twin reversed arterial perfusion (TRAP) sequence is one of the rare complications of multiple pregnancy and has been reported by only a few. Here, we report a case of monochorionic-triamniotic triplet pregnancy with TRAP sequence successfully treated with radiofrequency ablation, which did not develop polyhydramnios and heart failure although the estimated weight of the acardiac fetus increased twice as much as that of the direct pump fetus. Interestingly, the anastomosed blood vessels between the direct and indirect pump fetuses comprised a parallel circuit, which provided blood flow to the acardiac fetus. We hypothesized that the burden on the pump fetus in monochorionic pregnancy with TRAP sequence would be different between triplet and twin pregnancies.

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.

scholarly journals Monochorionic-Triamniotic Triplet Pregnancy Complicated by Twin Reversed Arterial Perfusion Sequence: Case Report and Literature Review

2017 ◽  
Vol 07 (02) ◽  
pp. e106-e110 ◽  
Author(s):  
Pingshan Pan ◽  
Guoyang Luo ◽  
Lu Tang ◽  
Jeanne Rolle ◽  
Yuqin Qin ◽  
...  
Keyword(s):  
Preterm Labor ◽  
Umbilical Artery ◽  
Ductus Arteriosus ◽  
Triplet Pregnancy ◽  
Arterial Perfusion ◽  
Preterm Premature Rupture ◽  
Trap Sequence ◽  
Vascular Connections ◽  
Twin Reversed Arterial Perfusion ◽  
Selective Fetal Reduction

Background Monochorionic-triamniotic pregnancies are rare and fraught with complications. Case A case of monochorionic-triamniotic triplet pregnancy complicated by twin reversed arterial perfusion (TRAP) sequence is presented. The patient declined termination or selective fetal reduction. Triplet C was acardiac. At 24 weeks, triplet B developed polyhydramnios. At 30 weeks, polyhydramnios was seen in all three amniotic sacs, but without signs of fetal hydrops and with normal Doppler velocimetry measurements in the umbilical artery, middle cerebral artery, and ductus arteriosus of triplets A and B. At 322/7 weeks, the patient presented with preterm premature rupture of membranes and preterm labor. Two live male infants were delivered by cesarean delivery weighing 1,350 and 1,390 g, respectively; the acardiac fetus weighed 1,460 g. Pathology examination revealed a single placenta weighing1,250 g, with evidence of direct vascular connections between triplets A and C as well as between triplets A and B. Conclusion Monochorionic-triamniotic triplet pregnancy with TRAP sequence is rare. Although the risk of complications is high, such pregnancies can be managed conservatively in select cases.

scholarly journals Invasive Procedures in Monochorionic Twins

2015 ◽  
Vol 9 (3) ◽  
pp. 280-292
Author(s):  
Aris Antsaklis ◽  
Panagiotis Antsaklis
Keyword(s):  
Chromosomal Abnormalities ◽  
Clinical Skills ◽  
Invasive Procedures ◽  
Monochorionic Twins ◽  
Monochorionic Twin ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Increased Risk ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion

ABSTRACT Monochorionic twin pregnancies (MC) are less frequent but they are considered higher risk pregnancies compared to dichorionic pregnancies. As a result, determining the chorionicity of a twin pregnancy is of vital importance for the surveillance and management of the pregnancy. The problem originates from the fact that monochorionic twins have one placenta, and as a result the circulation of the two fetuses is closely related to each other mainly through anastomosis of the placenta. The number and type of anastomosis is of great importance for the course of the pregnancy. Diagnosis of chromosomal abnormalities in such pregnancies requires excellent knowledge of invasive procedures and good clinical skills. Monochorionic twins are at increased risk for unique complications including twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and twin-reversed arterial perfusion (TRAP) sequence. Twin-to-twin transfusion syndrome is a very well known and described complication of monochorionic twin pregnancies and must be considered and checked in each monochorionic pregnancy. Selective feticide is not a method used very commonly in MC pregnancies, but may be applied in selected cases. For TTTS laser treatment of the anastomosis is a method of choice, but should be performed in centers with experience. How to cite this article Antsaklis A, Antsaklis P. Invasive Procedures in Monochorionic Twins. Donald School J Ultrasound Obstet Gynecol 2015;9(3):280-292.

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