Acardia anceps: the monster twin; twin reversed arterial perfusion (TRAP) syndrome

Shazia Khan; Tina Singh; Gunadhar Maiti

doi:10.18203/2320-1770.ijrcog20184547

Authors

Shazia Khan Department of Obstetrics and Gynecology, INHS Asvini, Mumbai, Maharashtra, India
Tina Singh Department of Obstetrics and Gynecology, INHS Kalyani, Vizag, Andhra Pradesh, India
Gunadhar Maiti Department of Obstetrics and Gynecology, CHEC, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20184547

Keywords:

Acardia anceps, Acardia twin, Monochorionic twin, TRAP sequence

Abstract

Twin reversed arterial perfusion (TRAP) sequence is an extremely rare complication of monochorionic multi-foetal pregnancy, occurring once in 35,000 births. It is characterized by a malformed foetus without a heart being perfused by a structurally normal (pump) twin via an artery-to-artery anastomosis in a reverse direction. We report one such case where ultrasound imaging revealed monochorionic twin pregnancy with a viable, normal-appearing first twin and a structurally aberrant second twin with absent cardiac activity. The patient was monitored with two weekly ultrasonography and Doppler ultrasound examination to ascertain the well-being of the pump twin. She delivered successfully at term a normal live baby and an acardius anceps foetus. The perinatal mortality of the pump twin ranges from 35 to 55%; making it essential to diagnose the presence of a pump twin at an early gestational age through improved imaging techniques to plan effective intervention at appropriate time.

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