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Case Reports
.2023 Sep 30;13(19):3109.
doi: 10.3390/diagnostics13193109.

"The Strange Case of Dr Pump and Mr Acardiac": The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies-Diagnosis, Prognosis and Management: Review of Literature

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Case Reports

"The Strange Case of Dr Pump and Mr Acardiac": The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies-Diagnosis, Prognosis and Management: Review of Literature

Pierpaolo Nicolì et al. Diagnostics (Basel)..

Abstract

The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the "acardiac") lacking autonomous placental blood supply and being perfused by the co-twin (the "pump"), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50-55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence.

Keywords: 3D ultrasound; early diagnosis; monochorionic twin pregnancy; transvaginal ultrasound; trap sequence.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A transabdominal ultrasound in a 22-week pregnant patient. (A) A 2D ultrasonography (longitudinal view) showing an amorph mass with a lower limb consisting of femur (blue arrow pointing to part of the femur) and sketches of tibia and fibula (star). (B) A 3D ultrasonography (lateral view) confirming the presence of thigh, leg, and foot. (C) A 3D picture (frontal view) showing in detail the foot with five toes.
Figure 2
Figure 2
Histological specimens. (A) A macroscopic view of the acardiac twin and the placenta at birth. (B) The acardiac twin had only a lower limb (with femur and sketches of tibia and fibula) ending with a formed five-toe foot, and sketches of testicles and an oedematous penis.
Figure 3
Figure 3
A transvaginal ultrasound in a 12-week pregnant patient. (A) The monster twin appeared as a hypo-hetero echoic mass with a rudimental vertebral column (white arrow) behind an anechoic cyst (red circle), and marked generalized edema of soft tissues (*). (B) An axial view of the monster twin showing femoral bones (blue arrows). (C) An Axial view of the monster twin highlighting retrograde umbilical perfusion (#) and absence of the heartbeat. (D) A sagittal view of the acardiac with 3D ultrasound technique showing anatomic details more clearly than the 2D standard way (the green arrow points to the sketch of a lower limb; * indicates the marked generalized edema of soft tissues).
Figure 4
Figure 4
A transabdominal ultrasound in a 14-week pregnant patient. (A) In the 2D grayscale image, the monster twin appeared bigger when compared to the previous ultrasound, so the rudimental vertebral column (white arrow), the anechoic cyst (red circle), and the edema of soft tissues (*) were more evident. (B) The color Doppler study showed a marked perfusion into the umbilical cord of the acardiac fetus. (C) A 2D image showing the lower limbs of the acardiac twin (green arrows). (D) A 3D picture showing the lower limbs of the acardiac (green arrow) over the twin pump’s back.
Figure 5
Figure 5
The picture displays a flowchart summing up how a monochorionic twin pregnancy complicated by TRAP can be managed. TA = transabdominal; TV = transvaginal; US = ultrasound; UA = umbilical artery; TOP = termination of the pregnancy.
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References

    1. Kashireddy P., Larson A., Minturn L., Ernst L. Case Report of Autopsy and Placental Examination After Radiofrequency Ablation of an Acardiac Twin. Lab. Med. 2015;46:248–253. doi: 10.1309/LM4B4DU7UIMKLNAI. - DOI - PubMed
    1. Van Gemert M.J., van den Wijngaard J.P., Vandenbussche F.P. Twin reversed arterial perfusion sequence is more common than generally accepted. Birth Defects Res. A Clin. Mol. Teratol. 2015;103:641–643. doi: 10.1002/bdra.23405. - DOI - PubMed
    1. Quaas P., Markfeld-Erol F. ‘TRAP-ped with an Acardius’: Case Series of Twin Reversed Arterial Perfusion (TRAP) Sequence and Review of Literature. J. Fetal Med. 2021;8:27–33. doi: 10.1007/s40556-020-00286-z. - DOI
    1. Scott J.M., Ferguson-Smith M.A. Heterokaryotypic monozygotic twins and the acardiac monster. J. Obstet. Gynaecol. Br. Commonw. 1973;80:52–59. doi: 10.1111/j.1471-0528.1973.tb02131.x. - DOI - PubMed
    1. Bieber F.R., Nance W.E., Morton C.C., Brown J.A., Redwine F.O., Jordan R.L., Mohanakumar T. Genetic studies of an acardiac monster: Evidence of polar body twinning in man. Science. 1981;213:775–777. doi: 10.1126/science.7196086. - DOI - PubMed

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