Key result
Conservative management of a monochorionic twin pregnancy complicated by TRAP sequence resulted in the successful delivery of a healthy pump twin at 34 weeks gestation.
Case Report (n=1)
No
Careful monitoring with ultrasonography and Doppler can facilitate successful term delivery of the pump twin in TRAP sequence.
May support conservative management in select TRAP cases; leaves open need for comparative trials before practice change.
Twin reversed arterial perfusion (TRAP) sequence is an extremely rare complication of monochorionic multi-foetal pregnancy, occurring once in 35,000 births. It is characterized by a malformed foetus without a heart being perfused by a structurally normal (pump) twin via an artery-to-artery anastomosis in a reverse direction. We report one such case where ultrasound imaging revealed monochorionic twin pregnancy with a viable, normal-appearing first twin and a structurally aberrant second twin with absent cardiac activity. The patient was monitored with two weekly ultrasonography and Doppler ultrasound examination to ascertain the well-being of the pump twin. She delivered successfully at term a normal live baby and an acardius anceps foetus. The perinatal mortality of the pump twin ranges from 35 to 55%; making it essential to diagnose the presence of a pump twin at an early gestational age through improved imaging techniques to plan effective intervention at appropriate time.
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Khan et al. (2018) conducted a case report in Twin reversed arterial perfusion (TRAP) syndrome (n=1). Conservative management was evaluated on Delivery outcome. Conservative management of a monochorionic twin pregnancy complicated by TRAP sequence resulted in the successful delivery of a healthy pump twin at 34 weeks gestation.
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