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Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Related Experiment Video

Updated: Aug 18, 2025

Author Spotlight: Advancing Spectral Characterization of Physiological and Malperfused Tissues
04:57

Author Spotlight: Advancing Spectral Characterization of Physiological and Malperfused Tissues

Published on: July 5, 2024

531

Twin Reversed Arterial Perfusion.

Punit Hans1

  • 1Obstetrics and Gynaecology, Patna Medical College, Patna, IND.

Cureus
|December 7, 2022
PubMed
Summary
This summary is machine-generated.

Twin reversed arterial perfusion (TRAP) sequence, a rare condition in monochorionic pregnancies, involves an acardiac twin being perfused by its co-twin. This case highlights a TRAP sequence undiagnosed until delivery, emphasizing the need for timely intervention.

Keywords:
acardiac twinmonochorionicmonochorionic diamniotictraptwin pregnancy

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Area of Science:

  • Obstetrics and Gynecology
  • Fetal Medicine
  • Maternal-Fetal Medicine

Background:

  • Twin reversed arterial perfusion (TRAP) sequence is a rare complication exclusive to monochorionic pregnancies.
  • It involves a shared placental circulation where one twin (acardiac) lacks a heart and is perfused retrogradely by the co-twin (pump twin).

Observation:

  • A case report details a 26-year-old patient at 37 weeks gestation presenting with vaginal leakage and non-reassuring fetal status.
  • The pregnancy was diagnosed as monochorionic diamniotic with TRAP sequence upon emergency cesarean delivery.
  • One twin was acardiac, while the pump twin was live but presented with massive ascites.

Findings:

  • The exact pathogenesis of TRAP sequence remains unclear, but placental vascular anastomoses and retrograde arterio-arterial blood flow are implicated.
  • This specific case was undiagnosed prenatally, underscoring diagnostic challenges.
  • The presence of an acardiac twin and pump twin with ascites indicates a poor prognostic factor.

Implications:

  • TRAP sequence requires prompt intervention, such as twin cord occlusion therapy or other fetal interventions.
  • Pregnancy termination is a viable option to prevent maternal obstetrical complications and morbidity.
  • Increased awareness and improved diagnostic methods for TRAP sequence in monochorionic pregnancies are crucial.