Twin reversed arterial perfusion syndrome: a rare but critical event of twin pregnancy

Urvashi Barman Singh, Akanksha Mishra, Kahkashan Bano


Twin-Reversed Arterial Perfusion (TRAP) sequence is also known as acardiac twin gestation or chorioangiopagus parasiticus, it is a rare and unique complication of monozygotic monochorionic twin pregnancies. 35 year old 8 gravida four alive issues and one spontaneous abortion. Patient came with complaint of pain in abdomen since 8 hours. She was having an ultrasonography report of twin pregnancy of 28 weeks gestation with one fetus alive and normal while other fetus was anomalous fetus FHS of first fetus was localised while FHS of other fetus was not localised. Twin-Reversed Arterial Perfusion (TRAP) sequence is a rare complication of monochorionic multiple gestation. Accurate antenatal diagnosis is essential to improve the prognosis of this rare entity.


Monochorionic twin, Twin-reversed arterial perfusion (TRAP), Acardiac twin, Amorphous twin

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James WH. A note on the epidemiology of acardiac monsters. Teratology. 1977;16:211-6.

Sogaard K, Skisted L, Brocks V. Acardiac twins: pathphysiology diagnosis, outcome and treatment. Six cases and review of the literature. Fetal Diagn Therapy. 1999;14:53-9.

Napolitani FD, Schreiber I. The acardiac monster: a review of the world literature and presentation of 2 cases. Am J Obstet Gynaecol. 1960;80:582-9.

Leite JMB, Couto JCF. Twin, acardiac at 24 weeks, 2009. Available at: Accessed 1 January 2010.

Mohanty C, Mishra OP, Singh CP, Das BK, Singla PN. Acardiac anomaly spectrum. Teratology. 2000;62:356-9.

Luiz N. Trap syndrome. Indian Paediatr. 2003;40:683-4.

Weisz B, Peitz R, Chayen B, Oren M, Zalel Y, Achiron R, et al. Tailored management of twin reversed arterial perfusion (TRAP) sequence. Ultrasound Obstet Gynaecol. 2004;23:451-5.

Moore T, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynaecol. 1990;163:907-12.

Peak B, Goldberg J, Albanese C. Prenatal diagnosis. World J Surg. 2003;27:27-37.

Tan TYT, Sepulveda W. Acardiac twin: a systematic review of minimally invasive treatment modalities Ultrasound Obstet Gynecol. 2003;22:409-19.

Hecher K, Hackelor BJ, Ville Y. Umbilical cord coagulation by microendoscopy at 16 weeks gestation in an acardiac twin. Ultrasound Obstet Gynaecol. 1997;10:130-2.