Prenatal identification of twin reversed arterial perfusion syndrome in the first trimester

Stiller, Robert J.; Romero, Roberto; Pace, Salvatore D.; Hobbins, John C.

doi:10.1016/0002-9378(89)90187-7

Cited by 31 publications

(15 citation statements)

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“…Color Doppler sonography may display reversed arterial blood flow from the placenta towards the acardiac twin. This has led to prenatal identification of the TRAP sequence [2][3][4] , giving rise to a variety of new therapeutic approaches. We report a case of prenatal diagnosis of the TRAP sequence by means of transvaginal color Doppler imaging at 12 weeks' gestation.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of twin reversed arterial perfusion sequence in the first trimester by transvaginal color Doppler ultrasound

Schwärzler

Ville

Moscosco

et al. 1999

Ultrasound in Obstet & Gyne

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A case of twin reversed arterial perfusion (TRAP) sequence was diagnosed at 12 weeks' gestation using transvaginal color Doppler ultrasound, which demonstrated the presence of retrograde perfusion in the umbilical artery of the abnormal twin. Ultrasound imaging showed a monochorionic-diamniotic twin pregnancy with an inappropriately grown second twin, the morphological evaluation of which revealed an abnormal cephalic pole with acrania, diffuse subcutaneous edema and the presence of cardiac activity in an abnormal heart with a single chamber.

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Section: Introductionmentioning

confidence: 99%

Diagnosis of twin reversed arterial perfusion sequence in the first trimester by transvaginal color Doppler ultrasound

Schwärzler

Ville

Moscosco

et al. 1999

Ultrasound in Obstet & Gyne

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“…The distinction criteria most widely accepted today are morphological; that is, the presence or absence of head, body and cardiac tissue. The frequency of acardia is estimated at 1/35,000 deliveries [1,2], but in our study it occurred in 1/18,000 deliveries.…”

Section: Discussionmentioning

confidence: 40%

“…This hemodynamic reversal, known as 'twin reversed arterial perfusion', leads to a total or partial agenesis of the heart in the recipient twin, in addition to an absence of one or more anatomical structures [1,2]. The survival and development of the acardiac fetus is strictly related to the presence of placental artery-to-artery anastomoses with the pump twin.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Anatomic Features of Acardiac Twins

Chanoufi¹,

Temime²,

Masmoudi

et al. 2004

Med Princ Pract

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Objective: To report 6 cases of acardiac twins, and to investigate prognostic factors that would lead to survival of the normal twin. Subjects and Methods: During a 9-year period from 1993 to 2001, 6 cases of acardiac twins out of 109,000 deliveries at the Maternity Center, Tunis, Tunisia were studied. Detailed inspection, X-rays, ultrasound and autopsies were performed. Results: Prenatal diagnosis was made in only 1 case at 33 weeks of gestation. Rudimentary cardiac tissue was observed in 2 of the 6 perfused twins, and the cephalic pole was less developed than other parts of the body. Severe agenesis or hypoplasia of the thoracoabdominal organs was commonly observed. Many limb malformations were observed, with arms the most affected. One of the pump twins was stillborn, 3 died between days 1 and 3 from respiratory distress, and 2 developed cardiac failure after birth and were treated with diuretics and digoxin, which led to a favorable outcome in only 1. The ratio of the weight of the acardiac to pump twin (TWR) ranged from 50 to 142%. Conclusion: The findings of this study indicate that acardia can be diagnosed by means of ultrasound in front of a monochorial twin pregnancy when one of the fetuses is deformed and has no cardiac activity. Heart failure and polyhydramnios, as well as a TWR greater than 50% are prognostic factors for the pump twin.

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“…Up until now there are three reports that, like us, have showed a delayed development of recognizable structures by serial ultrasound observations [9][10][11] . These observations support the hypothesis that the development is thoroughly disrupted but, in the hypoxemic milieu, some embryonic fields may still be vital enough to develop, while delayed, into recognizable structures.…”

Section: Discussionmentioning

confidence: 99%

Delayed Structural Development in an Acardiac Fetus: An Echographic Observation

Gaever

Defoort²,

Dhont³

2007

Fetal Diagn Ther

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Introduction: Twin reversed arterial perfusion (TRAP) is a rare condition in monozygotic multiple gestations, caused by the formation of large arterio-arterial anastomoses. Only few serial ultrasound observations are reported, showing the delayed development in the recipient twin. Case: A monochorionic monoamniotic twin pregnancy with discordant growth was diagnosed at 11 weeks and 4 days in a 28-year-old primigravida. The smaller twin, who first appeared as an amorphic mass, showed growth and developed a clearly recognizable spine and lower limbs in further ultrasound examinations. Conclusion: This case illustrates that developmental arrest in acardiac fetuses does not affect the total organism at one time, but that some embryonic fields keep on developing into macroscopically recognizable structures.

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Prenatal identification of twin reversed arterial perfusion syndrome in the first trimester

Cited by 31 publications

References 0 publications

Diagnosis of twin reversed arterial perfusion sequence in the first trimester by transvaginal color Doppler ultrasound

Diagnosis of twin reversed arterial perfusion sequence in the first trimester by transvaginal color Doppler ultrasound

Clinical and Anatomic Features of Acardiac Twins

Delayed Structural Development in an Acardiac Fetus: An Echographic Observation

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