A rare case of twin reversed arterial perfusion (TRAP) sequence
Rahat ARA and Caroline Chiew Ping TAN
Department of Obstetrics and Gynaecology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
ABSTRACT
Twin reversed arterial perfusion (TRAP) sequence is a rare, unique complication of monochorionic twin pregnancy in which one of the twins with an absent or a non-functioning heart (acardiac twin) is perfused by its own co-twin (pump twin) via placental arterial anastomosis. The anomalous twin may appear as a heterogenous mass simulating a teratoma or intrauterine foetal demise and has poorly developed heart, upper body and head. The normal twin faces the excess burden of having to send and receive blood from the acardiac mass as well as its own growing tissue and is at risk of heart failure and preterm birth. Left untreated, in up to 50% of cases, this otherwise normal twin may die in utero or shortly after birth. We report the case of a TRAP sequence in a monochorionic twin pregnancy. Unfortunately, the pump twin died because mother went into premature labour that was complicated by abruptio placenta at 26 weeks of gestation.
Keywords: Twins, monozygotic, placenta, ablation techniques
Correspondence author: Rahat ARA, Department of Obstetrics and Gynaecology, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam.
Tel: +673 8671072 or +673 2232024
E mail: rahatara@yahoo.com
Brunei Int Med J. 2012; 8 (5): 257-260