Spontaneous triplet pregnancy and trap sequence, case report.

Area of Science:

• Maternal-Fetal Medicine
• Reproductive Medicine
• Genetics

Background:

• Spontaneous triplet pregnancies occur in approximately 1 in 4000 births.
• Twin Reversed Arterial Perfusion (TRAP) sequence involves a pump fetus supplying an acardiac, non-viable twin through placental anastomoses.
• TRAP sequence is exceptionally rare in triplet pregnancies.

Observation:

• A 30-year-old patient presented with a monochorionic diamniotic triplet pregnancy.
• One fetus (A) was healthy; the second sac contained a pump fetus (B) and an acardiac twin (C).
• The acardiac twin (C) showed absent cranial and thoracic structures but had a measurable abdominal circumference.

Findings:

• The pregnancy was managed conservatively with twice-weekly ultrasounds.
• An emergency Cesarean section was performed at 35 4/7 weeks due to bradycardia in the pump fetus (B).
• Two healthy infants were delivered with good Apgar scores.

Implications:

• This case demonstrates successful conservative management of TRAP sequence in a triplet pregnancy without invasive procedures.
• Individualized treatment approaches are crucial, considering clinical status, acardiac twin size, and placental vascular connections.
• Conservative management can lead to favorable outcomes in select TRAP sequence triplet pregnancies.