Twin reversed arterial perfusion (TRAP) sequence: A case report and a brief literature review

Dhanju, Gurinder; Breddam, Alli

doi:10.1016/j.radcr.2022.02.057

Cited by 7 publications

(8 citation statements)

References 41 publications

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“…TRAPS is a condition unique to monochorionic twin [1]. Its incidence is on the increase due to early detection on first-trimester ultrasound scans and increased use of assisted reproductive technology [10].…”

Section: Discussionmentioning

confidence: 99%

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Twin reverse arterial perfusion sequence: A case report and literature review

Dickson

2023

Open J Clin Med Case Rep

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Twin reverse arterial perfusion sequence (TRAPS) is one of the complications of monochorionic twin gestation. It is characterised by large intertwined arterial-arterial anastomosis in which blood flows from one twin (pump twin) to the other twin (perfused twin) In a retrograde pattern. We report a case of monochorionic diamniotic twin gestation complicated by TRAPS in a 38-year-old G4P3 trader who was referred to the antenatal clinic of Rivers State University Teaching Hospital on account of unusual abdominal distension of one-week duration at 31 weeks gestational age. Ultrasound scan done at presentation showed a monochorionic diamniotic twin with the first twin in a transverse lie with an estimated foetal weight of 1.7kg, foetal heart rate of 150 beats per minute, and Twin 2, had no foetal head, no cardiac pulsation with significant tissue swelling. A diagnosis of TRAPS was made for which she was admitted and delivered by emergency caesarean section. The pump twin was admitted into the Special Care Baby Unit (SCBU) And succumbed to cardiac failure 24 hours after delivery

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Section: Discussionmentioning

confidence: 99%

“…TRAPS is a rare complication affecting 1% of monochorionic twin pregnancy [6] and [1] of 35000 pregnancies [7,8]. However, with the spread of assisted reproductive technology and improved diagnostic ultrasonography, the incidence of TRAPS is increasing towards 2.6% of monozygotic twins and [1] of 9500 to 11000 pregnancies [9,10].…”

Section: Introductionmentioning

confidence: 99%

Twin reverse arterial perfusion sequence: A case report and literature review

Dickson

2023

Open J Clin Med Case Rep

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“…To the best of our knowledge, the diagnosis of acardia is almost always made in the second [17][18][19][20][21][22][23] or third trimester [24][25][26] of gestation by means of transabdominal ultrasound. In some cases, the existence of the TRAP Sequence could even remain unknown until delivery [27,28], when the childbirth is preceded or followed by ambiguous amorph mass expulsion.…”

Section: Diagnosismentioning

confidence: 99%

“…According to Moore, if the ratio between the weight of the acardiac twin and that of the pump twin (APTW) is greater than 70:100 (0.7), the incidences of preterm delivery, polyhydramnios, and heart failure for the pump twin are 90%, 40%, and 30% respectively; when APTW is lower than 0.7, the incidences are 75%, 30%, and 10% [9]. In the literature, Moore's weight comparison between the monster and the normal twin has widely been used with sound confirmations of its goodness for predicting the outcome of TRAP pregnancies [18][19][20]22,24]. If we wanted to apply Moore's concept in our Case Report One, the estimated weight of our anomalous twin, based on a maximum length of 6.7 cm, was approximately 42.5 g. As per the William package, pump twin measured 480 g (Figure 3A), yielding a 0.09 ratio.…”

Section: Twins' Weight Ratiomentioning

confidence: 99%

“The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature

Nicolì,

Damiani,

Gaetani

et al. 2023

Diagnostics

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The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50–55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence.

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“… 2 , 3 Obstetric ultrasound imaging can diagnose TRAP syndrome, and Doppler examination confirms the reversed direction blood flow in the acardiac twin. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

Ultrasound Doppler findings of a Twin Reversed Arterial Perfusion Sequence (TRAP)

Amer,

Alshoabi,

Qurashi

et al. 2023

Pak J Med Sci

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Twin reversed arterial perfusion (TRAP) sequence is a rare pregnancy complication occurs in an identical twin pregnancy that share a single placenta. TRAP sequence is a twin’s pregnancy includes a normal-developed viable pump fetus and an abnormal usually nonviable acardiac fetus. The nonviable acardiac fetus depends on the pump fetus for his blood supply and put the pump fetus at risk of high cardiac output heart failure and congenital anomalies with high mortality rate. Gray-scale ultrasound and color and pulsed Doppler imaging is a noninvasive accessible imaging modality for the diagnosis of TRAP sequence. Early diagnosis of such conditions is mandatory in order to apply the proper therapeutic measures and to help the normal developed pump fetus to survive. The main goal of management is to interrupt blood supply to the nonviable acardiac fetus to reduce the strain on the heart of the pump fetus thus, increase the chance of survival. doi: https://doi.org/10.12669/pjms.40.1.8088 How to cite this: Amer SA, Alshoabi SA, Qurashi AA, Alhazmi FH, Al-Rudini RY. Ultrasound Doppler findings of a Twin Reversed Arterial Perfusion Sequence (TRAP). Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.8088 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Twin reversed arterial perfusion (TRAP) sequence: A case report and a brief literature review

Cited by 7 publications

References 41 publications

Twin reverse arterial perfusion sequence: A case report and literature review

Twin reverse arterial perfusion sequence: A case report and literature review

“The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature

Ultrasound Doppler findings of a Twin Reversed Arterial Perfusion Sequence (TRAP)

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