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.

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 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.

scholarly journals TRAP Sequence - An Interesting Entity in Twins

2012 ◽  
Vol 2 ◽  
pp. 56 ◽  
Author(s):  
R. H. Srinivas Prasad ◽  
T. Ramachandra Prasad ◽  
K. Dayananda Kumar
Keyword(s):  
Color Doppler ◽  
Color Doppler Imaging ◽  
Doppler Imaging ◽  
Arterial Perfusion ◽  
Prognostic Features ◽  
Trap Sequence ◽  
Rare Malformation ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence, is a rare malformation occurring in monozygotic multiple gestations. One well-developed normal (pump) twin and the other twin with absent cardiac structure (acardiac), who is hemodynamically dependent on the normal (pump) twin are characteristic of this syndrome. The acardiac twin develops multiple anomalies that make survival difficult. The prognosis of the pump twin is variable with mortality rate ranging from 50% to 70%. Complications that affect the prognosis of the pump twin include complications of congestive cardiac failure due to increased cardiac demand, prematurity secondary to preterm delivery, and polyhydramnios. Because of these complications prompt detection, follow-up, and treatment of this condition is very important. We report two cases of TRAP sequence that emphasizes the importance of gray-scale and color Doppler imaging in diagnosis, detection of poor prognostic features, follow-up, and management of TRAP sequence.

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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