scholarly journals An incidental rare finding of a TRAP sequence during a caesarean section: A case report

2021 ◽  
Vol 8 (2) ◽  
pp. 264-266
Author(s):  
Shivangi Sharma ◽  
Minal Choudhary
Keyword(s):  
Caesarean Section ◽  
Upper Body ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Arterial Anastomosis ◽  
Umbilical Arteries ◽  
Twin Pregnancies ◽  
Normal Twin ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is an anomaly of monochorionic twin pregnancies where one twin has an absent, non-functioning or rudimentary heart while the other twin may be normal. The condition occurs because of early development of arterio -arterial anastomoses between the umbilical arteries of twin foetuses that share a fused placenta. In this condition, the affected anomalous (acardiac twin) is perfused by the normal twin (pump twin) via an arterio-arterial anastomosis. The affected twin (acardiac twin) presents with malformations such as absent (acradia) or rudimentary heart, underdeveloped or missing head, upper body and limbs. As pump twin has to provide circulation to itself as well as the perfused twin, this increased burden to perfuse acardiac twin increases the risk of developing cardiac failure in pump twin. Here we present such a case of 22-year-old, which was diagnosed per operatively during caesarean section at department of obstetrics & gynecology, Rukshamaniben General Hospital, Ahmedabad.

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.

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 Rare Case of Acardiac Twin

2011 ◽  
Vol 3 (1) ◽  
pp. 46-48
Author(s):  
Manisha Damani
Keyword(s):  
Blood Circulation ◽  
Rare Case ◽  
Rare Condition ◽  
Normal Growth ◽  
Interesting Case ◽  
Upper Body ◽  
Lower Body ◽  
Acardiac Twin ◽  
Normal Twin ◽  
Pump Twin

ABSTRACT This is a very rare condition happening on average once in every 35000 pregnancies. One twin is usually normal. The other is body like tissue often with malformed legs and lower body but no upper body or heart. Abnormal blood vessels on the placental surface allow the normal twin (pump twin) to pump blood through the tissues of abnormal twin. Because the pump twin heart has to pump for two, there is high risk of going into heart failure and death of normal twin. In our cases nature miraculously interrupted the blood circulation to acardiac twin which resulted in normal growth of normal twin. I present here this interesting case diagnosed and followed up and delivered at our institution.

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 ‘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 Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

2018 ◽  
Vol 20 (3) ◽  
pp. 396
Author(s):  
Andrei Mihai Malutan ◽  
Marina Dudea ◽  
Camelia Albu ◽  
Razvan Ciortea ◽  
Doru Diculescu ◽  
...  
Keyword(s):  
Twin Pregnancy ◽  
Female Fetus ◽  
Monochorionic Twin ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
First Case ◽  
Retroplacental Hematoma ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion

Twin reversed arterial perfusion (TRAP) sequence is a rare and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). We report on the case of a33-year-old female with a biamniotic monochorionic twin pregnancy complicated with TRAP sequence and polyhydramnios. The patient underwent fetoscopic termination of the acardiac twin and at 34 gestational weeks (GW) was readmitted with aretroplacental hematoma. The patient gave birth through caesarean section to a living female fetus, weighing 1480 g. To the best of our knowledge, this is the first case reporting a twin pregnancy with TRAP sequence complicated with retroplacental hematoma.

scholarly journals Advances in Ultrasonic Assessment of Acardiac Twin

2011 ◽  
Vol 5 (3) ◽  
pp. 213-218
Author(s):  
Florin Stamatian ◽  
Daniel Muresan ◽  
Gabriela Caracostea ◽  
Tunde Kovacs
Keyword(s):  
Reverse Flow ◽  
Subcutaneous Tissue ◽  
Rare Complication ◽  
Final Diagnosis ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Fetal Movements ◽  
Ultrasonic Assessment ◽  
Pump Twin

ABSTRACT The development of an acardiac anomaly, one of the most severe human malformations, is a rare complication unique to monochorionic multiple pregnancies. In this condition, the primary malformation is the lack of a well-defined cardiac structure in one twin (the acardiac twin), which is kept alive by its structurally normal co-twin (the pump twin). The final diagnosis for a twin pregnancy with an acardiac twin may be established after the 9th week, when the cephalic extremity and limbs can be precisely determined. Direct signs that lead to the diagnosis of an acardiac twin include the absence of cardiac and fetal movements, difficult visualization of the trunk and cephalic poles, thickening of subcutaneous tissue and the presence of umbilical artery reverse flow towards the acardiac fetus mass. The pump fetus may demonstrate hydramnios, cardiomegaly and heart failure. Once an acardiac anomaly is diagnosed, both the acardiac and pump twins should be assessed to classify the pregnancy according to prognostic factors based on the size and growth of the acardiac twin and the cardiovascular condition of the pump twin. Assessing the extent of heart damage in the pump fetus is a key step in pregnancy management. There are two available options, either conservative or interventional, for the management of these pregnancies. Serial ultrasound surveillance is important for detecting any worsening of the condition, which may suggest the need for interventions to optimize the pump-twin's chance for survival. We performed a retrospective analysis of three cases of monochorionic twin pregnancies diagnosed with a twin reversed arterial perfusion (TRAP) sequence during the first and second trimesters. We compared our data with those offered by a review of the literature.

scholarly journals Acardiac Acephalus Twin Pregnancy

2019 ◽  
Vol 10 (1) ◽  
pp. 89-91
Author(s):  
Shamim Rima ◽  
Gule Tajkia ◽  
Sharmin Siddika ◽  
Md Tarik Aziz ◽  
Rumana Amin ◽  
...  
Keyword(s):  
Blood Supply ◽  
Umbilical Artery ◽  
Monozygotic Twins ◽  
The Body ◽  
Upper Body ◽  
Arterial Perfusion ◽  
Medical College ◽  
Acardiac Twin ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Occurrence of acardiac twin is due to twin reversed arterial perfusion sequence (TRAP) occurring early in embryogenesis. There is vascular communication between the twins in monozygotic twins. The vascular communication in acardiac twin is different, in that, the acardiac twin receives blood supply from other twin pump through umbilical artery. The blood in the umbilical artery is mostly deoxygenated. Hence it leads to secondary organ atrophy. Upper body does not develop at all, hence missing heart and head. All the blood supply to the acardiac twin is derived from the pump twin. The acardiac twin develops only lower part of the body or just a mass of tissue. Hence, the mortality for acardiac twin is 100%. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 89-91

scholarly journals Conservative management of a case of a cardiac anceps twin reversed arterial perfusion sequence misdiagnosed as vanishing twin: a case report

2020 ◽  
Vol 10 (1) ◽  
pp. 385
Author(s):  
Jharna Behura ◽  
Ayushi Sinha ◽  
Aafreen Naaz ◽  
Soni Bharti
Keyword(s):  
Conservative Management ◽  
Multiple Pregnancy ◽  
Cardiac Activity ◽  
Laser Coagulation ◽  
Variable Degree ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is a specific, rare and severe complication of monochorionic multiple pregnancy, which is characterized by one normal fetus (pump twin) and another with no cardiac activity and variable degree of deficient development of the head and upper limbs. The management of these pregnancies are a real challenge due to the parasitic hemodynamic dependence of the acardiac twin on the pump twin. The aim of management is to maximize the chances of survival of the pump twin with some intervention. The preferred management suggested is elective ultrasound-guided laser coagulation or radiofrequency ablation of the umbilical cord vessels at 11-13 weeks when the survival is 70-75%. Delay in intervention until 16-18 weeks is associated with spontaneous cessation of blood flow in the acardiac twin in 60% of cases and in about 50% of these there is death or brain damage in the pump twin. However, pregnancies diagnosed late need to follow a tailored approach with expectant management. The authors report a case of TRAP twin sequence which on ultrasound was diagnosed as a case of vanishing twin at 20 weeks. Subsequently on follow up ultrasound, it was diagnosed as a trap sequence with the pump twin developing polyhydramnios at 30 weeks. She was counselled regarding the prognosis of the pump twin and she opted for conservative management. Weekly ultrasound and color doppler were done. The amniotic fluid index (AFI) decreased gradually at 33 and 35 weeks, there were no signs of congestive cardiac failure of the pump twin on Doppler studies and she had a spontaneous delivery of a healthy male child and an acardiac anceps fetus at 36weeks and 5 days. The perinatal mortality of a pump twin managed conservatively ranges from 35 to 55%. It is essential to diagnose the presence of trap sequence at an early gestational age through improved imaging techniques to plan a timely and effective intervention to salvage most of the pump twins.

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