Monochorionic Triplet Pregnancies With Twin Reversed Arterial Perfusion and Acardiac Triplet: Report of Two Cases and Literature Review

2021 ◽  
pp. 109352662098414
Author(s):  
Ami Mon ◽  
James Yip ◽  
Ivica Zalud ◽  
Karen S Thompson
Keyword(s):  
Literature Review ◽  
Preterm Labor ◽  
Poor Prognosis ◽  
Case Reports ◽  
Expectant Management ◽  
Large For Gestational Age ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Twin Reversed Arterial Perfusion ◽  
Invasive Intervention

TRAP pregnancies involving monochorionic triplets are extremely rare, calculated to be 1 in 4.5 million. We report two cases of monochorionic triplet pregnancies with an acardiac triplet. In one case, the mother was a 33-year-old G2P1 who underwent dilation and evacuation at 20 weeks due to poor prognosis. The other case involved a 21-year-old G1P0 mother presenting in advanced preterm labor at 21 weeks who elected expectant management. Seventeen cases of monochorionic triplets with TRAP were identified in the literature. Invasive intervention was performed in 10 cases; 9 cases resulted in the survival of the nonacardiac twins and 1 case resulted in the survival of 1 fetus. Our two cases had common sonographic features which included polyhydramnios of all fetuses. Placental features shared between both cases included being large for gestational age and velamentous insertion of the acardiac twin. The acardiac twins in both of our cases were hydropic and demonstrated developed pelvis and lower extremities. One had an omphalocele. Most case reports in the literature review demonstrate similar findings. Two cases of monochorionic triplets with TRAP and acardiac twin are herein described. Successful treatment by invasive interventions have been described in this condition, highlighting the importance of early diagnosis.

Acardiac Twin: A Rare Case Report

2016 ◽  
Vol 7 (3) ◽  
pp. 103-104 ◽  
Author(s):  
Nimisha N Srivastava ◽  
Tulsi Bhatia ◽  
Jayshree Narshetty
Keyword(s):  
Case Report ◽  
Preterm Labor ◽  
Rare Case ◽  
Monochorionic Twin ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Rare Case Report ◽  
Diagnostic Modalities ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin

Abstract The incidence of multifetal pregnancies has dramatically increased due to assisted reproductive technology. As a result, preterm labor, Preterm premature rupture of the membranes, congenital anomalies and fetal losses are commonly encountered by obstetricians. Despite advances in diagnostic modalities and prenatal care, many times the complications associated with multifetal pregnancies may remain undiagnosed. Complications are more with monochorionic twin gestation due to placental sharing. “Twin – reversed arterial perfusion” sequence or “acardiac twin” is one such complication. This case report presents an antenatally undiagnosed monochorionic twin pregnancy, resulting in preterm delivery of a healthy, normal twin along with an acardiac acephalus co-twin. How to cite this article Srivastava NN, Bhatia T, Narshetty J, Kumar S. Acardiac Twin: A Rare Case Report. Int J Infertil Fetal Med 2016;7(3):103-104.

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 Twin Reversed Arterial Perfusion (TRAP) Syndrome or acardiac twin: a case report in Madagascar

2018 ◽  
Vol 6 (5) ◽  
pp. 1790
Author(s):  
Lyn Z. A. Rabetsimamanga ◽  
Hary F. Rabarikoto ◽  
Maheriandrianina F. V. Rajaonarivony ◽  
Setriny M. Ravoavy ◽  
Hery R. Andrianampanalinarivo
Keyword(s):  
Twin Pregnancy ◽  
Rare Complication ◽  
Cardiac Activity ◽  
Upper Body ◽  
Premature Delivery ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Gestational Week ◽  
Short Time ◽  
Twin Reversed Arterial Perfusion

TRAP syndrome is a rare complication of monochorionic twin pregnancy. It is characterized by the association of an acardiac twin with a healthy twin. The acardiac twin is a parasite who put the healthy twin at high risk of cardiac failure. We report a case in a 25-year-old Malagasy woman, primigravida, who had a consultation at gestational week 31 for significant dyspnea and a threat of premature delivery. Ultrasound scans discovered an acute polyhydramnios, fetus with anasarca and low cardiac activity, and a para-fetal mass. She gives birth to a male newborn and an acardiac twin without head an upper body. The first twin died short time after birth.

scholarly journals Therapeutic dilemma in twin reversed arterial perfusion sequence

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983634
Author(s):  
Yoko Aoyagi ◽  
Kentaro Kai ◽  
Masahiro Sumie ◽  
Naoki Fujiyoshi ◽  
Yuichi Furukawa ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Growth Retardation ◽  
Japanese Woman ◽  
Anatomical Location ◽  
Fetal Growth Retardation ◽  
Third Trimester ◽  
Arterial Perfusion ◽  
The Third ◽  
Acardiac Twin ◽  
Twin Reversed Arterial Perfusion

The dissemination of minimally invasive in utero surgery reduced the mortality of twin reversed arterial perfusion sequence, but the mortality of expectantly treated surgical candidates remains high. A 26-year-old, non-parous, Japanese woman at 13 weeks of gestation had been diagnosed with twin reversed arterial perfusion sequence and was judged as a surgical candidate for radiofrequency ablation. However, she did not undergo surgery because of the anatomical location of the acardiac twin. At 18 weeks of gestation, the blood flow to the acardiac twin disappeared spontaneously. The pump twin began to demonstrate fetal growth retardation during the third trimester. The patient delivered a 1891 g female at term. We macroscopically identified the cause of the fetal growth retardation as velamentous insertion of the umbilical cord and microscopically diagnosed the acardiac twin with acardiac acephalus. We should give the same attention to the management of post–twin reversed arterial perfusion sequence as twin reversed arterial perfusion sequence itself.

MCMA acardiac twin: a trap?

2017 ◽  
Vol 6 (7) ◽  
pp. 3182
Author(s):  
Vinayachandran S. ◽  
Vedhapriya Sudhakar
Keyword(s):  
Rare Complication ◽  
Expectant Management ◽  
Monozygotic Twin ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Retrograde Perfusion ◽  
Arterial Anastomosis ◽  
Pump Twin

Acardiac twining or Twin Reverse Arterial Perfusion (TRAP) is a rare complication of monozygotic twin occurring due to retrograde perfusion of acardiac twin by structurally normal pump twin through abnormal arterio-arterial anastomosis in the placenta. Here we report a case of unexpected occurrence of acardiac twin diagnosed as monozygotic monoamniotic twin (MCMA) gestation with single foetal demise due to multiple anomalies, delivered vaginally suggesting a role for expectant management.

scholarly journals A case report of twin reversed arterial perfusion sequence with expectant management

2017 ◽  
Vol 7 (2) ◽  
pp. 1-6
Author(s):  
Aşkı Ellibeş Kaya ◽  
Alper Basbug ◽  
Derya Başbuğ ◽  
Çiğdem Pulatoğlu ◽  
Ozan Dogan
Keyword(s):  
Case Report ◽  
Expectant Management ◽  
Arterial Perfusion ◽  
Twin Reversed Arterial Perfusion

Acardiac Twin with Externalized Intestine Adherent to Placenta: Unusual Manifestation of Omphalocele

2004 ◽  
Vol 7 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Shawn Clark Emery ◽  
Keith K. Vaux ◽  
Dolores Pretorius ◽  
Eliezer Masliah ◽  
Kurt Benirschke
Keyword(s):  
Blood Flow ◽  
Cardiac Development ◽  
Past Medical History ◽  
Significant Past Medical History ◽  
Maternal Complications ◽  
Unusual Manifestation ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin

TRAP (twin reversed arterial perfusion) syndrome produces an acardiac twin (acardiac monster, acardius, acardiacus, chorioangiopagus parasiticus, etc.). Acardiacs result from monozygotic multiple births in which three anatomic anomalies occur: (1) a fetus' cardiac development is disturbed; (2) artery–artery anastomosis carries blood from a normal (“pump”) twin to the acardiac; (3) vein–vein anastomosis carries blood from the acardiac back to the normal twin. Whether reversal of blood flow in the acardiac results from or causes cardiac dysmorphogenesis has not been resolved. Acardiac twins demonstrate a complex constellation of malformations usually thought to result from reversed blood flow; omphalocele is particularly common. We report monochorionic monoamnionic male twins in which an acardiac twin demonstrated externalized intestines adherent to the placenta. The twins were delivered from a 30-year-old primigravida mother by cesarean section without maternal complications at 33 w. The mother has no significant past medical history. The macerated acardius had a 4-cm long attenuated umbilical cord with indeterminate number of vessels. Structures rostral to the thorax were absent save for one poorly developed hand and arm. The abdomen contained loose mesenchyme and no organs. The entire intestine (21 cm) along with two testes was located in a sac on the surface of the placenta. No histopathologic anomalies of formed structures were identified aside from spatial relationships and incomplete development. The normal twin required no intensive care and is doing well. To our knowledge, this is the first report of externalized intestine, which may represent an unusual consequence of omphalocele.

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