Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

Hawraa Mohamad; Hassan Barakat; Charlotte E. Hajjar; George Wehbe; Kariman Ghazal

doi:10.18203/2320-1770.ijrcog20232969

Authors

Hawraa Mohamad Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
Hassan Barakat Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
Charlotte E. Hajjar Department of Obstetrics and Gynaecology, Rafik Hariri University Hospital, Beirut, Lebanon
George Wehbe Department of Oncology Obstetrics and Gynaecology, Rafik Hariri University Hospital, Beirut, Lebanon
Kariman Ghazal Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; Department of Obstetrics and Gynaecology, Rafik Hariri University Hospital, Beirut, Lebanon

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232969

Keywords:

TRAP sequence, VBAC, Acardiac twin, Ultrasound

Abstract

Twin reversed arterial perfusion (TRAP) sequence results from aberrant and asymmetrical twinning. It is a rare but serious complication of monozygotic twin pregnancies. It is characterized by a normally formed fetus that shows features of heart failure, and an acardiac twin. A 26-year-old pregnant woman, gravida 6, para 5, with mono-chorionic di-amniotic twin pregnancy at her 20^th week of gestation, was diagnosed with TRAP sequence. Both the pump twin and the acardiac co-twin did not display any cardiac activity. Termination of pregnancy was accomplished by a successful vaginal birth after cesarean section (VBAC) following five prior cesarean sections. Proper and early diagnosis of TRAP sequence can aid in treatment selection and pump twin salvage. Induction of labor by both misoprostol and intracervical balloon catheter showed to be safe and effective in a woman with a uterine scar resulting from five prior cesarean sections.

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