Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10214
Peer-review started: April 21, 2022
First decision: May 30, 2022
Revised: June 9, 2022
Accepted: August 23, 2022
Article in press: August 23, 2022
Published online: October 6, 2022
Processing time: 158 Days and 20.9 Hours
Twin reversed arterial perfusion (TRAP) sequence is an extremely rare congenital anomaly in monochorionic (MC) twins. The condition is characterized by a malformed fetus (acardiac twin) without cardiac activities being perfused by a structurally normal one (pump twin) via an artery-to-artery anastomosis in a reverse direction.
We described the first case of TRAP to receive laser surgery in Vietnam. The 26-wk pregnancy was originally misdiagnosed in another hospital as MC twins with single intrauterine fetal death. Following admission to our center, the diagnosis was amended to a 26-wk TRAP sequence stage IIb. The acardiac twin was 7.5 cm at the longest length, the ratio of the weight of the acardiac twin to the weight of the pump twin was more than 90%, the pump twin showed fetal distress with absent diastolic flow in umbilical artery of pump twin, and the peak systolic velocity in the middle cerebral artery = 1.6 MoM. We performed emergency laser photocoagulation of the acardiac twin’s umbilical cord. After surgery, we suc
TRAP should be appropriately diagnosed and treated early to avoid complications of the pump twin. Fetoscopic laser photocoagulation is a new and effective treatment for this condition.
Core Tip: It is an easy mistake to misdiagnose twin reversed arterial perfusion as a single intrauterine fetal death, especially in our case, as the acardiac twin has a head, body, and full limbs. Intrauterine fetal intervention is necessary when the pump twin shows signs of fetal distress. After surgery, the problem of premature rupture of membranes and delivery should be noted. The indication to terminate the pregnancy depends on the mother’s condition, fetal condition, and the acardiac twin’s longest size.