December 18th, 2017

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Title:
Twin Reversed Arterial Perfusion: A Case Report
Authors:  Sarah Woodman, M.D., Avni Segal, M.D., and Jay Goldberg, M.D.
 
BACKGROUND: Twin reversed arterial perfusion (TRAP) is a rare complication of monochorionic twin pregnancies. This sequence occurs in 1% of monochorionic twins and approximately 1 in 35,000 to 50,000 pregnancies.

CASE: A 27-year-old woman, gravida 3, para 2-0-0-2, at unknown gestational age presented to the emergency department with a chief complaint of abdominal pain. Pelvic examination revealed an edematous fetal head protruding from the vagina. The patient reportedly did not know she was pregnant. The patient was transferred to labor and delivery, where she delivered a stillborn neonate of approximately 28–30 weeks’ gestation and weighing 408 g. The patient also delivered a smaller, macerated stillborn that was consistent with an acardiac twin weighing 167 g.

CONCLUSION: It is thought that TRAP is caused by a large artery-to-artery placental shunt through a single placenta. In this case, the recipient twin had failure of the fetal head to fully develop, gastroschisis, and 2 identifiable rudimentary limbs, which is called acardius anceps or paracephalus. The donor twin lacked genitalia and lower limbs. If TRAP is recognized by ultrasound, radiofrequency ablation can be performed by cauterizing umbilical vessels in the recipient twin to stop blood flow.
Keywords:  diseases in twins; fetal transfusion syndrome; fetofetal transfusion; twin reversed arterial perfusion; twin transfusion syndrome; twins; twins, monozygotic
   
   
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