BACKGROUND Twin reversed arterial perfusion(TRAP) sequence is an extremely rare congenital anomaly in monochorionic(MC) twins.The condition is characterized by a malformed fetus(acardiac twin) without cardiac activiti...BACKGROUND Twin reversed arterial perfusion(TRAP) sequence is an extremely rare congenital anomaly in monochorionic(MC) twins.The condition is characterized by a malformed fetus(acardiac twin) without cardiac activities being perfused by a structurally normal one(pump twin) via an artery-to-artery anastomosis in a reverse direction.CASE SUMMARY We described the first case of TRAP to receive laser surgery in Vietnam.The 26-wk pregnancy was originally misdiagnosed in another hospital as MC twins with single intrauterine fetal death.Following admission to our center,the diagnosis was amended to a 26-wk TRAP sequence stage IIb.The acardiac twin was 7.5 cm at the longest length,the ratio of the weight of the acardiac twin to the weight of the pump twin was more than 90%,the pump twin showed fetal distress with absent diastolic flow in umbilical artery of pump twin,and the peak systolic velocity in the middle cerebral artery = 1.6 Mo M.We performed emergency laser photocoagulation of the acardiac twin’s umbilical cord.After surgery,we successfully maintained the pregnancy for 8 wk and ended it electively by cesarean section at 34 wk of gestation due to rupture of membranes.CONCLUSION TRAP should be appropriately diagnosed and treated early to avoid complications of the pump twin.Fetoscopic laser photocoagulation is a new and effective treatment for this condition.展开更多
To editor:This study reports a pregnant woman who was naturally conceived with monochorionic triamniotic(MCTA)combined with twin reversed arterial perfusion(TRAP).An ultrasound revealed that one of the fetuses had a c...To editor:This study reports a pregnant woman who was naturally conceived with monochorionic triamniotic(MCTA)combined with twin reversed arterial perfusion(TRAP).An ultrasound revealed that one of the fetuses had a cardiac malformation,and a connection between the umbilical arteries was suspected.To reduce the acardiac fetus,radiofrequency ablation was performed at 17+3 weeks of pregnancy.At 36+4 weeks,two healthy infants were delivered via elective cesarean section.Postoperative examination revealed a direct connection between the umbilical arteries,with the placental perfusion acting as a direct pump.It is essential to identify the intrauterine status of the blood-supplying infant and vascular connections in order to achieve successful outcomes in pregnancies with complications,such as edema and heart failure.The studies involving human participants were reviewed and approved by Human Research Ethics Committee of Tianjin Central Hospital of Obstetrics and Gynecology.The patient provided her written informed consent to participate in this study.展开更多
The twin reversed arterial perfusion (TRAP) sequence is an anomaly unique to monochorionic multiple pregnancies. It is a rare complication. We present a case of acardius anephus, which was mistaken for a live anomalou...The twin reversed arterial perfusion (TRAP) sequence is an anomaly unique to monochorionic multiple pregnancies. It is a rare complication. We present a case of acardius anephus, which was mistaken for a live anomalous singleton fetus. A 21-year-old unbooked Primigravida was seen in labour ward with a ten hours history of labour pains. Urgent transabdominal ultrasound revealed a singleton live fetus at 30 weeks gestation with gross cystic mass lesion at the level of the abdomen and polyhydramnious.?Caesarean section confirms a twin gestation with monoamniotic monochorionic single placenta. The umbilical cord of the acardiac twin was short—First twin was a live female baby, weighing 1000 g. TRAP is a rare event an early referral to feto maternal unit will improve perinatal outcome.展开更多
Acardiac twinning or TRAP-sequence is a rare complication of monochorionic twin pregnancy. We present a case in which fetal demise of one fetus of a twin pregnancy had been wrongly diagnosed in the first trimester as ...Acardiac twinning or TRAP-sequence is a rare complication of monochorionic twin pregnancy. We present a case in which fetal demise of one fetus of a twin pregnancy had been wrongly diagnosed in the first trimester as a vanishing twin. This resulted in the unexpected occurrence of an acardiac twin in the third trimester, culminating in an acardiac twin with a birth weight higher than that of the normal twin. A review is presented on therapeutic opportunities including ligation of the umbilical cord under ultrasound or fetoscopy. This case report highlights the need for correct and early ultrasonographic diagnosis of chorionicity and detailed ultrasonographic follow-up of twin pregnancies.展开更多
文摘BACKGROUND Twin reversed arterial perfusion(TRAP) sequence is an extremely rare congenital anomaly in monochorionic(MC) twins.The condition is characterized by a malformed fetus(acardiac twin) without cardiac activities being perfused by a structurally normal one(pump twin) via an artery-to-artery anastomosis in a reverse direction.CASE SUMMARY We described the first case of TRAP to receive laser surgery in Vietnam.The 26-wk pregnancy was originally misdiagnosed in another hospital as MC twins with single intrauterine fetal death.Following admission to our center,the diagnosis was amended to a 26-wk TRAP sequence stage IIb.The acardiac twin was 7.5 cm at the longest length,the ratio of the weight of the acardiac twin to the weight of the pump twin was more than 90%,the pump twin showed fetal distress with absent diastolic flow in umbilical artery of pump twin,and the peak systolic velocity in the middle cerebral artery = 1.6 Mo M.We performed emergency laser photocoagulation of the acardiac twin’s umbilical cord.After surgery,we successfully maintained the pregnancy for 8 wk and ended it electively by cesarean section at 34 wk of gestation due to rupture of membranes.CONCLUSION TRAP should be appropriately diagnosed and treated early to avoid complications of the pump twin.Fetoscopic laser photocoagulation is a new and effective treatment for this condition.
基金National Key Specialized Disease Queue project(GJZDZKZBDL2022-04)National Natural Science Foundation of China(82001579)Natural Science Foundation of Tianjin(22JCYBJC01110).
文摘To editor:This study reports a pregnant woman who was naturally conceived with monochorionic triamniotic(MCTA)combined with twin reversed arterial perfusion(TRAP).An ultrasound revealed that one of the fetuses had a cardiac malformation,and a connection between the umbilical arteries was suspected.To reduce the acardiac fetus,radiofrequency ablation was performed at 17+3 weeks of pregnancy.At 36+4 weeks,two healthy infants were delivered via elective cesarean section.Postoperative examination revealed a direct connection between the umbilical arteries,with the placental perfusion acting as a direct pump.It is essential to identify the intrauterine status of the blood-supplying infant and vascular connections in order to achieve successful outcomes in pregnancies with complications,such as edema and heart failure.The studies involving human participants were reviewed and approved by Human Research Ethics Committee of Tianjin Central Hospital of Obstetrics and Gynecology.The patient provided her written informed consent to participate in this study.
文摘The twin reversed arterial perfusion (TRAP) sequence is an anomaly unique to monochorionic multiple pregnancies. It is a rare complication. We present a case of acardius anephus, which was mistaken for a live anomalous singleton fetus. A 21-year-old unbooked Primigravida was seen in labour ward with a ten hours history of labour pains. Urgent transabdominal ultrasound revealed a singleton live fetus at 30 weeks gestation with gross cystic mass lesion at the level of the abdomen and polyhydramnious.?Caesarean section confirms a twin gestation with monoamniotic monochorionic single placenta. The umbilical cord of the acardiac twin was short—First twin was a live female baby, weighing 1000 g. TRAP is a rare event an early referral to feto maternal unit will improve perinatal outcome.
文摘Acardiac twinning or TRAP-sequence is a rare complication of monochorionic twin pregnancy. We present a case in which fetal demise of one fetus of a twin pregnancy had been wrongly diagnosed in the first trimester as a vanishing twin. This resulted in the unexpected occurrence of an acardiac twin in the third trimester, culminating in an acardiac twin with a birth weight higher than that of the normal twin. A review is presented on therapeutic opportunities including ligation of the umbilical cord under ultrasound or fetoscopy. This case report highlights the need for correct and early ultrasonographic diagnosis of chorionicity and detailed ultrasonographic follow-up of twin pregnancies.
