TRAP sequence – A case of successful conservative management

Authors

  • Ana Varejão Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
  • Mariana Dória Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos https://orcid.org/0000-0003-0144-8168
  • Mafalda Laranjo Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos https://orcid.org/0000-0002-3604-1918
  • Fátima Soares Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
  • Inês Sarmento Gonçalves Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v33.i1.26665

Keywords:

acardiac twin, monochorionic, multiple pregnancy, pump twin, TRAP sequence

Abstract

Twin reversed arterial perfusion (TRAP) is a rare sequence that complicates monochorionic multiple pregnancies. This condition affects both fetuses - the acardiac twin and the pump twin.  This report presents the case of a monochorionic multiple pregnancy complicated by TRAP diagnosed in the first trimester. After clarifying the couple and multidisciplinary discussion, conservative management was chosen because no genetic abnormalities or complications were identified in the normal twin development throughout pregnancy, and the acardiac twin stopped growing at 16 weeks, resulting in a vaginal term delivery of a healthy baby. In utero intervention is currently the first-line treatment option in these cases, but several studies have reported the benefits of an expectant approach. The optimal approach has not yet been established. 

Downloads

Download data is not yet available.

Author Biography

Inês Sarmento Gonçalves, Department of Gynaecology and Obstetrics, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos

Assistente Hospitalar, Serviço de Ginecologia e Obstetrícia, Hospital Pedro Hispano, Porto, Portugal 

References

van Gemert MJC, van den Wijngaard JPHM, Vandenbussche FPHA. Twin reversed arterial perfusion sequence is more common than generally accepted. Birth Defects Res Part A - Clin Mol Teratol. 2015;103(7):641–3.

Gillim DL, Hendricks CH. Holoacardius - Review of the literature and a case report. 1953. p. 647–53.

Steffensen TS, Gilbert-Barness E, Spellacy W, Quintero RA. Placental pathology in trap sequence: Clinical and pathogenetic implications. Fetal Pediatr Pathol. 2008;27(1):13–29.

Pasquini L, Wimalasundera RC, Fisk NM. Management of other complications specific to monochorionic twin pregnancies. Best Pract Res Clin Obstet Gynaecol. 2004;18(4):577–99.

Shettikeri A, Acharya V, Shailaja S, Sahana R, Radhakrishnan P. Outcome of Pregnancies Diagnosed with TRAP Sequence Prenatally: A Single-Centre Experience. Fetal Diagn Ther. 2019;560038.

Pagani G, D’Antonio F, Khalil A, Papageorghiou A, Bhide A, Thilaganathan B. Intrafetal laser treatment for twin reversed arterial perfusion sequence: Cohort study and meta-analysis. Ultrasound Obstet Gynecol. 2013;42(1):6–14.

van Gemert MJC, Ross MG, Nikkels PGJ, Wijngaard JPHM va. den. Acardiac twin pregnancies part III: Model simulations. Birth Defects Res Part A - Clin Mol Teratol. 2016;106(12):1008–15.

Gemert MJC Van, Pistorius LR, Benirschke K, Bonsel GJ, Vandenbussche FPHA, Paarlberg KM, et al. Hypothesis Acardiac Twin Pregnancies : Pathophysiology-Based Hypotheses Suggest Risk Prediction by Pump / Acardiac Umbilical Venous Diameter Ratios. 2015.

Buyukkaya A, Tekbas G, Buyukkaya R. Twin reversed arterial perfusion (TRAP) sequence; Characteristic gray-scale and doppler ultrasonography findings. Iran J Radiol. 2015;12(3):1–3.

Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol [Internet]. 1990;163(3):907–12. Available from: http://dx.doi.org/10.1016/0002-9378(90)91094-S.

Yıldırım E. Spontaneous triplet pregnancy and trap sequence, case report. BMC Pregnancy Childbirth. 2019;19(1):328.

Mone F, Devaseelan P, Ong S. Intervention versus a conservative approach in the management of TRAP sequence: a systematic review. J Perinat Med. 2016;44(6):619-29. doi: 10.1515/jpm-2015-0165. PMID: 26356357.

Sullivan AE, Varner MW, Ball RH, Jackson M, Silver RM. The management of acardiac twins: A conservative approach. Am J Obstet Gynecol. 2003;189(5):1310–3.

Ziki EM, Chirenje ZM, Madziyire MG. A case of twin reversed arterial perfusion (TRAP) sequence managed conservatively. Pan Afr Med J. 2019;32:1–4.

Barbier M, Petrovic M, Simon P, Khiat S, D’Ercole C, Blanc J. TRAP sequence in a monochorionic diamniotic pregnancy: A rare and unpredictable syndrome. Eur J Obstet Gynecol Reprod Biol. 2020;247(2019):259–61.

Downloads

Published

2024-04-05

How to Cite

1.
Varejão A, Dória M, Laranjo M, Soares F, Sarmento Gonçalves I. TRAP sequence – A case of successful conservative management. REVNEC [Internet]. 2024Apr.5 [cited 2025Feb.22];33(1):49-52. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/26665

Issue

Section

Case Reports

Most read articles by the same author(s)