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.

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.

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.

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

Twin Reversed Arterial Perfusion Syndrome

1998 ◽  
Vol 47 (2) ◽  
pp. 75-87 ◽  
Author(s):  
W. Malinowski ◽  
W. Wierzba
Keyword(s):  
Prenatal Diagnosis ◽  
High Risk ◽  
Twin Pair ◽  
Multiple Pregnancy ◽  
Cardiac Activity ◽  
Monochorionic Twin ◽  
Literature Research ◽  
Arterial Perfusion ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion

AbstractTwin reversed arterial perfusion (TRAP) syndrome is a rare but severe complication of monozygotic monochorionic twin pregnancies. The outcome is invariably fatal for the abnormal twins and for 50-75% of the normal co-twins. The prenatal diagnosis of the TRAP always has to be presumed in a multiple pregnancy within which a twin pair grows whenever cardiac activity can not be proved echographically. We present discuss – based upon literature research – pathogenic mechanisms, pathologic-anatomic, echographic diagnosis and management of these high-risk pregnancies.

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.

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