Abstract
BackgroundTwin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin.Case presentationA 32-year-old Hispanic primigravida was referred to our clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical “whirlpool sign” at 26 weeks of gestation, and intrauterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm premature rupture of membranes occurred, and an emergency cesarean section was performed. The newborn was diagnosed in the early neonatal period with intestinal perforation. The diagnosis was postnatally confirmed by surgery and histopathology.ConclusionsThe type of fetal intervention and late gestational age of the procedure increase the risk of complications. This case alerts health providers to be vigilant in the follow-up of patients with complicated monochorionic pregnancies.
Highlights
Intestinal volvulus is a rare condition in which the small bowel and proximal colon twist around the superior mesenteric artery
If the Twin reversed arterial perfusion (TRAP) sequence is left untreated, a substantial proportion of pump twins die in utero up to 18 weeks of gestation, and 50% of the remainder die in the further course of pregnancy or in the neonatal period as a result of prematurity [12]
Case presentation A 32-year-old Hispanic primigravida with a spontaneous pregnancy was referred to our institution after a fetoscopic procedure of laser coagulation of anastomoses at 18 weeks of gestation due to TRAP sequence
Summary
The type of fetal intervention and late gestational age of the procedure increase the risk of complications.
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