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- Title
TRAP SEQUENCE.
- Authors
GUERRA, Manuel; Banderas, Belen; Carson, Claudia; Leiva, Paz; Morales, Nereida; Vasquez, Patricio; Haye, Maria Teresa; Gutierrez, Jorge
- Abstract
Background. The TRAP sequence is a very rare fetal pathology observed in 1% of monochorionic twin pregnancies, and 1 in every 35,000 deliveries. There are several theories about its etiology, being the vascular the most accepted. The principle of blood perfusion in this type of gestation is associated with the presence of placental vascular anastomosis and retrograde arterial perfusion that allow the survival of a fetus with alterations, at the expense of a normal one. The acardic twin has a mortality of 100% and the normal twin has a mortality of up to 60% according to the published series. They are classified according to the degree of development of the acardiac twin: acardio - acéphalus; acardio -acornus; acardio - amorphous; myelacephalus and acardio - aneceps; the latter being the most differentiated. Case report. Patient information. A healthy 22-year-old G P0 woman at 15 weeks' gestation starts her prenatal control. Initial diagnostic. At 17 weeks' of monochorionic monoamniotic pregnancy. Ultrasound examination highlights: twin 1 with preserved fetal anatomy and umbilical vein impressing with increased caliber; twin 2, with preserved limbs, head, thorax and abdomen, and the presence of a nutrient vessel that irrigates upper body, without identifiable cardiac structure, and reverse flow in the umbilical artery. Intervention. At 17+6 weeks' gestation a fetoscopy is performed: photocoagulation and umbilical cord section of twin 2. Twin 1 is progressing favorably. It is kept with a periodical follow-up. Results. At 3 weeks' gestation, after premature rupture of the membranes, a healthy twin was born through vaginal delivery (weight 2502 grs, APGAR score 6-8). Conclusion. The TRAP sequence is an uncommon, lethal pathology for the recipient twin and, potentially, for the donor twin. Intrauterine therapy increase the survival rate of the donor twin up to 80-90%.
- Subjects
SERBIA; CONFERENCES &; conventions; FETAL ultrasonic imaging; THROMBOCYTOPENIA absent radius syndrome; FETUS
- Publication
Journal of Perinatal Medicine, 2017, Vol 45, p246
- ISSN
0300-5577
- Publication type
Article
- DOI
10.1515/jpm-2017-3002