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The TRAP (twin reversed arterial perfusion) sequence - case presentation.
Claudiu Mărginean1, Maria Oana Mărginean, Daniel Mureşan
1Department of Pediatrics I, University of Medicine and Pharmacy of Tirgu Mures, Romania; oanamarg93@gmail.com.
Summary
This case study details a rare Twin Reversed Arterial Perfusion (TRAP) sequence with severe fetal malformations. Early ultrasound diagnosis and interventions are crucial for improving survival in the donor twin.
Area of Science:
- Perinatology
- Fetal Medicine
- Teratology
Background:
- Twin Reversed Arterial Perfusion (TRAP) sequence is a rare complication in monochorionic pregnancies.
- It involves an acardiac twin (receptor) perfused by a normal donor twin via an umbilical artery-to-artery anastomosis.
Observation:
- A 26-year-old primigravid woman with a monochorionic-diamniotic pregnancy presented with polyhydramnios at 26 weeks.
- Ultrasound revealed a TRAP sequence with a viable donor fetus and a severely malformed, non-viable receptor fetus.
- The receptor twin exhibited multiple anomalies including rudimentary heart and brain, abdominal wall defects, absent bladder, and pulmonary agenesis.
Findings:
- Post-delivery, anatomopathological examination confirmed TRAP sequence with severe facial dysmorphism, phocomelia, and a univentricular hypoplastic heart in the receptor twin.
- A vascular anastomosis between the umbilical cords was identified as the likely cause of perfusion.
- Anemia and cardiac failure in the donor twin are potential complications leading to mortality.
Implications:
- Accurate diagnosis of TRAP sequence via ultrasound is critical for timely management.
- Close monitoring with weekly ultrasounds and consideration of intrauterine interventions can improve donor twin survival.
- This case highlights the extreme end of malformations associated with TRAP sequence, emphasizing the importance of early detection.
