Twin Reversed Arterial Perfusion Sequence: A Case Report and Literature Review
Journal of Case Reports in Medical Science, Volume 9, Issue 1,
Twin reversed 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 150beats 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.
Monochorionic pregnancy complicated by TRAPS is associated with poor foetal outcomes. Early diagnosis and adequate management will enhance clinical outcomes. The diagnosis of TRAPS requires a high index of suspicion. Clinicians and radiologists need to be aware of the features in order to make prompt diagnosis and take appropriate action which may include early referral to the fetal medicine unit for appropriate intervention and improved outcome for the pump twin.
- multiple gestation
How to Cite
Berg C, Holst D, Mallmann MR, Gottschalk I, Gembruch U, Geipel A. Early vs late intervention in twin reversed arterial perfusion sequence. Ultrasound in Obstetrics & Gynecology. 2014;43(1):60-4.
Sueters M, Oepkes D. Diagnosis of twin-to-twin transfusion syndrome, selective fetal growth restriction, twin anaemia-polycythaemia sequence, and twin reversed arterial perfusion sequence. Best Practice & Research Clinical Obstetrics & Gynaecology. 2014;28(2):215-26.
Osaghae DO, Unuigbe JA. Transfusion syndromes in monochorionic multiplets: An overview. Tropical Journal of Obstetrics and Gynaecology. 2016;33(2):135-42.
Sugibayashi R, Ozawa K, Sumie M, Wada S, Ito Y, Sago H. Forty cases of twin reversed arterial perfusion sequence treated with radio frequency ablation using the multistep coagulation method: A single‐center experience. Prenatal diagnosis. 2016;36(5):437-43.
Adamou N, Yakasai I. Twin reverse arterial perfusion (TRAP): Case report. Open Journal of Obstetrics and Gynecology. 2014;4(16):1072-6.
Cabassa P, Fichera A, Prefumo F, Taddei F, Gandolfi S, Maroldi R, Frusca T. The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature. European Journal of Obstetrics &Gynecology and Reproductive Biology. 2013;166(2):127-32.
Tavares de Sousa M, Glosemeyer P, Diemert A, Bamberg C, Hecher K. First‐trimester intervention in twin reversed arterial perfusion sequence. Ultrasound in Obstetrics & Gynecology. 2020;55(1):47-9.
Dhanju G, Breddam A. Twin reversed arterial perfusion (TRAP) sequence: A case report and a brief literature review. Radiology Case Reports. 2022;17(5):1682-91.
Oluwafemi RO, Owa O. Acephalic Nigerian newborn: a case report. Ann Biomed Sci. 2019;18(2):25-28.
Shettikeri A, Acharya V, Shailaja V, Sahana R, Radhakrishnan P. Outcome of pregnancies diagnosed with TRAP sequence prenatally: a single-centre experience. Fetal Diagnosis and Therapy. 2020;47(4):301-6.
Badoe EV, Darko A, Atuguba BH. Case report: Twin reversed arterial perfusion sequence in a triplet natural pregnancy: Case report from Korle Bu Teaching Hospital, Accra, Ghana and a Review of the Literature. West African Journal of Medicine. 2013;32(1):73-5.
Boele CO, Johnson A; twin reversed arterial perfusion sequence: Best practice and research clinical Obstetrics and Gynaecology. 2022;84:127-42.
Bukar M, Kwari SD, Bilkisu I, Mahmud MG, Obed JY. Acardiac acephalus twin: A case report. Tropical Journal of Obstetrics and Gynaecology. 2012;29(1):131-3.
Rohilla M, Chopra S, Suri V, Aggarwal N, Vermani N. Acardiac-acephalus twins: A report of 2 cases and review of literature. The Medscape Journal of Medicine. 2008; 10(8):200-208
Pagani G, D'antonio F, Khalil A, Papageorghiou A, Bhide A, Thilaganathan B. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta‐analysis. Ultrasound in Obstetrics & Gynecology. 2013;42(1):6-14.
Sebire NJ, Wong AE, Sepulveda W. Minimally invasive management of twin revered arterial perfusion sequence (TRAP). Fetal and Maternal Medicine Review. 2006; 17(1):1-22.
Chaveeva P, Poon LC, Sotiriadis A, Kosinski P, Nicolaides KH. Optimal method and timing of intrauterine intervention in twin reversed arterial perfusion sequence: case study and meta-analysis. Fetal diagnosis and therapy. 2014;35(4):267-79.
Okai T, Ichizuka K, Hasegawa J, Matsuoka R, Nakamura M, Shimodaira K, Sekizawa A, Kushima M, Umemura S. First successful case of non‐invasive in‐utero treatment of twin reversed arterial perfusion sequence by high‐intensity focused ultrasound. Ultrasound in Obstetrics & Gynecology. 2013;42(1): 112-4.
Livingston JC, Lim FY, Polzin W, Mason J, Crombleholme TM. Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): A single-center experience. American journal of obstetrics and gynecology. 2007;197(4):399-e1.
Scheier M, Molina FS. Outcome of twin reversed arterial perfusion sequence following treatment with interstitial laser: A retrospective study. Fetal diagnosis and therapy. 2012;31(1):35-41.
Abstract View: 13 times
PDF Download: 2 times