Abstract
BackgroundMonochorionic diamniotic triplet pregnancies are rare. Twin reversed arterial perfusion sequence in monochorionic triplet pregnancies is extremely rare, and it is associated with high perinatal morbidity and mortality rates in the “pump fetus.”Case presentationWe reported a case of monochorionic diamniotic triplet pregnancy with twin reversed arterial perfusion sequence, including two acardiac fetuses sharing a single amniotic sac and a normal fetus in another amniotic sac. Due to rapid growth of the acardiac fetuses, intrafetal laser therapy was performed in both of them under ultrasound guidance at 15 weeks +5 days. Subsequently, regular and careful antenatal care including fetal ultrasonography and doppler and fetal echocardiography was conducted. At 37 weeks +4 days, a healthy female baby weighing 2510 g was delivered. The baby was followed up and now at 11 months old is in good health.ConclusionsTwin reversed arterial perfusion sequence in monochorionic triplet pregnancy should be diagnosed early by ultrasound imaging during pregnancy. Individualized management should be based on clinical conditions to improve the perinatal outcome of the pump twin. Intrafetal laser therapy could be an alternative procedure when intrauterine intervention is required.
Highlights
We reported a successful application of intrafetal laser therapy in an extremely rare case of Monochorionic diamniotic (MCDA) triplet pregnancy with two acardiac fetuses and successful delivery of a healthy newborn at term at the West China Second University Hospital, a tertiary referral center in western China
Due to rapid growth of the acardiac fetuses, after repeated extensive counseling about the predicted poor prognosis of the pump fetus (Fetus 1) during expectant management, intrafetal laser therapy was performed under ultrasound guidance at 15 weeks + 5 days
We used a list of keywords including “twin reversed arterial perfusion sequence,” “tripletTwin reversed arterial perfusion (TRAP) sequence,” “acardiac fetus,” “acardiac twin,” “triplets,” “triplet pregnancy,” and “multiple pregnancy” to perform an extensive search of literature in English and Chinese about the perinatal management and outcomes of monochorionic triplet pregnancies with TRAP sequence
Summary
Twin reversed arterial perfusion sequence in monochorionic triplet pregnancy should be diagnosed early by ultrasound imaging during pregnancy.
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