scholarly journals Use of the Tei Index in the Conservative Management of TRAP Sequence Pregnancies Diagnosed during the Periviable Period: A Case Series

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Kristina Martimucci ◽  
Theresa Kuhn ◽  
Robyn Bilinski ◽  
Jesus Alvarez-Perez
Keyword(s):  
Interventional Procedure ◽  
Rare Complication ◽  
Case Series ◽  
Second Trimester ◽  
Third Trimester ◽  
Tei Index ◽  
Fetal Demise ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
High Output

Twin Reverse Arterial Perfusion (TRAP) Sequence is a rare complication of monochorionic pregnancies. Without intervention, the viable pump twin in a case of TRAP Sequence may develop high output cardiac failure leading to an intrauterine fetal demise. We present 3 cases of TRAP Sequence pregnancy diagnosed during the second or third trimesters of pregnancy. There are minimal sonographic tools for the guidance of a fetal therapeutic interventional procedure during the second trimester or timing of delivery during the third trimester to reduce morbidity and mortality of a viable fetus. Tei index may be a useful sonographic tool in the management of TRAP Sequence during the second or third trimester of pregnancy.

Fetal Vascular Malperfusion Due To Long and Hypercoiled Umbilical Cords Resulting in Recurrent Second Trimester Pregnancy Loss: A Case Series and Literature Review

2020 ◽  
pp. 109352662096206
Author(s):  
Jonathan C Slack ◽  
Theonia K Boyd
Keyword(s):  
Umbilical Cord ◽  
Rare Event ◽  
Case Series ◽  
Second Trimester ◽  
Fetal Demise ◽  
Flow Restriction ◽  
Intrauterine Fetal Demise ◽  
Increased Risk ◽  
Second Trimester Pregnancy ◽  
Umbilical Cords

Background Intrauterine fetal demise due to fetal vascular malperfusion in mid-gestation is a rare occurrence. Abnormally long and hypercoiled umbilical cords are associated with an increased risk of umbilical cord blood flow restriction, which in turn can result in adverse perinatal and maternal outcomes. The factors that regulate umbilical cord development, specifically umbilical cord length and coiling, are poorly understood. Methods Maternal history, along with fetal and placental findings (post-mortem, pathological, and molecular), were reviewed for a series of 3 consecutive pregnancies that ended in second trimester intrauterine fetal demise. Results All 3 umbilical cords were exceptionally long and hypercoiled, and all placentas showed evidence of high-grade fetal vascular malperfusion. At fetopsy, all 3 fetuses were developmentally normal for gestational age and lacked congenital anomalies. Maternal medical history and antenatal testing (including an extensive work-up for maternal hypercoagulability syndromes) were normal and/or noncontributory. Conclusion Although excessively long and hypercoiled cords are generally thought of as sporadic, nongenetic events, rare examples of recurrent intrauterine fetal demise secondary to such exist have been reported. This intrafamilial clustering of a rare event is suggestive that at least a subset of hypercoiled, long umbilical cords may have an underlying genetic etiology.

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

2016 ◽  
Vol 40 (2) ◽  
pp. 110-115 ◽  
Author(s):  
Maiko Wagata ◽  
Takeshi Murakoshi ◽  
Keisuke Ishii ◽  
Jin Muromoto ◽  
Jun Sasahara ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Color Doppler ◽  
Fetal Demise ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Internally Cooled ◽  
Gestational Age At Delivery ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Objective: The study aims to evaluate the efficacy of radiofrequency ablation (RFA) with an internally cooled electrode for twin reversed arterial perfusion (TRAP) sequence. Methods: From April 2008 through December 2014, we retrospectively reviewed all patients who underwent RFA with an internally cooled electrode for TRAP sequence at 3 tertiary referral centers in Japan. Results: Twenty-five monochorionic diamniotic twin pregnancies underwent RFA with an internally cooled electrode for TRAP sequence at 16-27 weeks of gestation. In all cases, umbilical cord blood flow cessation in the acardiac twin was confirmed by ultrasonography with color Doppler. There were 2 cases of procedure-related complications: 1 case of unintentional septostomy and 1 case of anemia in a pump twin. Fetal demise of the pump twin occurred in 3 (12%) cases. Twenty-two (88%) of 25 pump twins were delivered alive. The median gestational age at delivery was 36 + 3 weeks (range 25 + 2-40 + 5 weeks). There were 14 cases (64%) of premature deliveries before 37 weeks and 5 (23%) before 32 weeks. Conclusion: RFA with an internally cooled electrode is a feasible and effective procedure for the treatment of TRAP sequence.

scholarly journals A Case of Trap Sequence with Immense Acardiac Twin

Folia Medica ◽  
2014 ◽  
Vol 56 (2) ◽  
pp. 129-132
Author(s):  
Georgi I. Amaliev ◽  
Maria L. Malinova ◽  
Blagovest K. Pehlivanov ◽  
Hristina A. Ivancheva
Keyword(s):  
Twin Pregnancy ◽  
Rare Complication ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Complicated Pregnancy ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin ◽  
Pump Twin

Abstract Twin-reversed arterial perfusion sequence is a rare complication of monochorionic twin pregnancy in which an anomalous acardiac fetus is hemodynamically dependent on its structurally normal “pump” twin. Early diagnosis is essential for improving perinatal prognosis for the normal twin. In this case report we present a case of TRAP sequence with immense acardiac twin with favorable outcome, emphasizing the importance of ultrasound imaging, follow-up and timing of delivery in this complicated pregnancy.

scholarly journals Mid-trimester rupture uterus: case series

2017 ◽  
Vol 7 (1) ◽  
pp. 342
Author(s):  
Aishwarya Kapur ◽  
Sudha Prasad ◽  
Sangeeta Gupta
Keyword(s):  
Uterine Rupture ◽  
Epigastric Pain ◽  
Rare Event ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Second Trimester ◽  
Third Trimester ◽  
First Case ◽  
Obstetric Intervention ◽  
Scarred Uterus

Uterine rupture is an obstetric catastrophe with significant maternal and fetal morbidity and mortality which occurs mainly in the third trimester of pregnancy or during labour, especially in previously scarred uterus. The occurrence of rupture in first and second trimester in women with unscarred uteri is quite rare. We report two cases of rupture uteri managed in our centre at 24 and 26 weeks gestation in women with unscarred uteri. First case was G3P1L1A1, 24 weeks with epigastric pain, stable vitals, epigastric tenderness, USG inconclusive, CT scan showed out pouching of amniotic sac through fundus. Laparotomy done, there was 8-9 cm fundal rupture extending between cornua, uterine repair done. Second case was G3P1L1A1 26 weeks with abdominal pain, stable vitals, corresponding fundal height, head engaged, USG revealed outpouching amniotic sac at the fundus. Laparotomy performed, there was 10 cm rent extending trans-fundal, uterine repair done. Unscarred uterine rupture, especially in early pregnancy is a rare event, posing significant difficulty in diagnosis. Uterine rupture should be first ruled out in all pregnant women presenting with acute abdomen irrespective of gestational age. Search for non-gynaecological causes can delay crucial obstetric intervention that can lead to loss of obstetric function, morbidity and mortality.

scholarly journals Acute Fatty Liver Disease of Pregnancy in the Second Trimester

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Faraz Afridi ◽  
Michael Feely ◽  
Raju Reddy
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Fulminant Liver Failure ◽  
Second Trimester ◽  
Third Trimester ◽  
Fetal Demise ◽  
The Third ◽  
History Of ◽  
Acute Fatty Liver

Acute fatty liver of pregnancy (AFLP) is a rare disorder that typically presents in the third trimester. We report a case of a 21-year-old woman with a history of intrauterine fetal demise at 19 weeks’ gestation who developed fulminant liver failure 1 week after the fetal demise. She was diagnosed with AFLP as per the Swansea criteria. An orthotopic liver transplant was attempted but was unsuccessful. AFLP usually presents between the 30th to 38th weeks of gestation. However, it can occur in the postpartum period after only 19 weeks of gestation as highlighted in our case.

scholarly journals Acardia anceps: the monster twin; twin reversed arterial perfusion (TRAP) syndrome

2018 ◽  
Vol 7 (11) ◽  
pp. 4775
Author(s):  
Shazia Khan ◽  
Tina Singh ◽  
Gunadhar Maiti
Keyword(s):  
Imaging Techniques ◽  
Rare Complication ◽  
Cardiac Activity ◽  
Well Being ◽  
Reverse Direction ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Live Baby ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is an extremely rare complication of monochorionic multi-foetal pregnancy, occurring once in 35,000 births. It is characterized by a malformed foetus without a heart being perfused by a structurally normal (pump) twin via an artery-to-artery anastomosis in a reverse direction. We report one such case where ultrasound imaging revealed monochorionic twin pregnancy with a viable, normal-appearing first twin and a structurally aberrant second twin with absent cardiac activity. The patient was monitored with two weekly ultrasonography and Doppler ultrasound examination to ascertain the well-being of the pump twin. She delivered successfully at term a normal live baby and an acardius anceps foetus. The perinatal mortality of the pump twin ranges from 35 to 55%; making it essential to diagnose the presence of a pump twin at an early gestational age through improved imaging techniques to plan effective intervention at appropriate time.

scholarly journals ‘TRAP-ped with an Acardius’: Case Series of Twin Reversed Arterial Perfusion (TRAP) Sequence and Review of Literature

2021 ◽  
Vol 8 (1) ◽  
pp. 27-33
Author(s):  
Philipp Quaas ◽  
Filiz Markfeld-Erol
Keyword(s):  
Clinical Course ◽  
Heart Function ◽  
Case Series ◽  
Review Of Literature ◽  
Severe Condition ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin

AbstractTwin reversed arterial perfusion (TRAP) sequence is a rare but severe condition that affects monochorionic (MC) multifetal pregnancies. In twin pregnancies, it is characterized by a normally developed twin and another twin with missing heart function (acardiac twin or TRAP twin). A variety of risks and complications may affect the normal twin. Management of such pregnancies can be either expectant or interventional. We report four cases of TRAP sequence treated in our institutions and supply an overview on currently existing literature. This case series demonstrates the heterogeneity in manifestations and clinical course of patients affected by this condition. Furthermore, it includes an acardius amorphous of considerable size delivered at 35.6 weeks of gestation.

TRAP) Secuencia de perfusión arterial reversa en embarazo gemelar monocoriónico con feto acárdico. Caso Clínico.

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Edwin Vargas Llerena ◽  
Severino Rey ◽  
German Herrera ◽  
Alexandra Robayo
Keyword(s):  
English Literature ◽  
Perinatal Outcomes ◽  
It Management ◽  
Second Trimester ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin ◽  
Made In

Objetive: Develop a review of the pathophysiology, diagnosis, treatment and management of reversed arterial perfusion.The reversed arterial perfusion sequence, known in English literature as TRAP sequence (twin reversed arterial perfusion (1), pathology associated with complications of monochorionic twin pregnancy, (2) is the absence of a well-defined cardiac structure on a twin (the acardiac twin), which is kept alive by his co-twin (the pump twin) through an arterial-arterial surface placental anastomosis. (3) the normal twin accompanying the acardiac has a mortality of 60% ; morbidity is mainly associated with congestive heart failure (4) while the acardiac twin has a mortality of 100% Apropos of a case reversed arterial perfusion syndrome TRAP diagnosed in the second trimester of pregnancy will be displayed and evaluate it. Management made in the service of Gynecology, service image and Pathology service and the associated perinatal outcomes. Keywords: acardic Fetus, perfusion sequence reversed arterial, sequence TRAP, monochorionic pregnancy twin

scholarly journals Twin Reversed Arterial Perfusion Sequence: A Rare Entity

2015 ◽  
Vol 5 ◽  
pp. 9
Author(s):  
Sachin Khanduri ◽  
Saakshi Chhabra ◽  
Anshul Raja ◽  
Saurav Bhagat
Keyword(s):  
Gestational Age ◽  
Imaging Techniques ◽  
Rare Complication ◽  
Well Being ◽  
Reverse Direction ◽  
Intrauterine Pregnancy ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is an extremely rare complication of monochorionic multi-fetal pregnancy, occurring once in 35,000 births. This condition is characterized by a malformed fetus without a cardiac pump being perfused by a structurally normal (pump) twin via an artery-to-artery anastomosis in a reverse direction. We report a case of a primigravida, who came for routine antenatal checkup to our hospital at 31 weeks gestational age. Ultrasound imaging and magnetic resonance imaging revealed twin monochorionic intrauterine pregnancy with a viable, normal-appearing first twin and amorphous structured second twin connected by umbilical vessels. The patient was monitored with weekly ultrasonography, echocardiography, and Doppler ultrasound examination to ascertain the well-being of the pump twin. She delivered successfully at term a normal live baby and an acardius acephalus fetus. Plain X-ray of the acardius acephalus fetus confirmed the absence of cephalic structures. The perinatal mortality of the pump twin ranges from 35 to 55%; hence, it is essential to diagnose the presence of a pump twin at an early gestational age through improved imaging techniques, so that intervention can be planned early in the pregnancy for a better outcome of the pump twin.

MINIMALLY INVASIVE MANAGEMENT OF TWIN REVERSED ARTERIAL PERFUSION SEQUENCE (TRAP)

2006 ◽  
Vol 17 (1) ◽  
pp. 1-22 ◽  
Author(s):  
NJ SEBIRE ◽  
AE WONG ◽  
W SEPULVEDA
Keyword(s):  
Rare Complication ◽  
Intrauterine Death ◽  
Apparent Lack ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Arterial Blood ◽  
Underlying Pathophysiology ◽  
Invasive Management ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Acardiac anomaly, twin reversed arterial perfusion (TRAP) sequence or chorioangopagus parasiticus are synonymous terms referring to a rare complication unique to monochorionic multiple pregnancies in which there is apparent lack of a well-formed cardiac structure in one fetus (the acardiac twin), which is abnormally perfused by a structurally normal co-twin (the pump twin) through a single superficial artery-to-artery placental anastomosis. The condition therefore results in arterial blood flowing in a retrograde fashion from the pump twin towards the affected fetus, and this underlying pathophysiology indicates the preferred use of the clinical term TRAP-sequence. Pathophysiologically, the acardiac fetus acts as a parasite that can only survive in-utero as it is haemodynamically dependent upon the pump twin. The principal perinatal problems being associated with the TRAP sequence are pump-twin congestive heart failure, polyhydramnios and severe preterm delivery, although intrauterine death of the pump twin has been reported even in the absence of such features.

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