Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

Twin reversed arterial perfusion (TRAP) sequence results from aberrant and asymmetrical twinning. It is a rare but serious complication of monozygotic twin pregnancies. It is characterized by a normally formed fetus that shows features of heart failure, and an acardiac twin. A 26-year-old pregnant woman, gravida 6, para 5, with mono-chorionic di-amniotic twin pregnancy at her 20th week of gestation, was diagnosed with TRAP sequence. Both the pump twin and the acardiac co-twin did not display any cardiac activity. Termination of pregnancy was accomplished by a successful vaginal birth after cesarean section (VBAC) following five prior cesarean sections. Proper and early diagnosis of TRAP sequence can aid in treatment selection and pump twin salvage. Induction of labor by both misoprostol and intracervical balloon catheter showed to be safe and effective in a woman with a uterine scar resulting from five prior cesarean sections.