P05.15: Diagnosis and treatment of triplet pregnancy complicated with twin reversed arterial perfusion—case report

Abstract

Twin reversed arterial perfusion (TRAP) as complication of multiple pregnancies occurs in 1 : 100 monochorionic twins. Aim of this case was a description of diagnosis and treatment the triplets pregnancy complicated with TRAP. 32 year-old women (GII.PII) was diagnosed at the 20 weeks of gestation and the monochorionic diamniotic (MCDA) TRAP sequence combined with a singleton third fetus was recognized. The biometry of both normal triplets was equal to gestational age and the concordant their growth. Arterial and venous Doppler flows was normal in both fetuses, echocardiography examination revealed the normal heart anatomy and function also in both (cardiovascular profile score was – 10 points). Due to polyhydramnios in amniotic sac of pump twin we performed amniodrainage twice and the patient was qualified to invasive treatment in Leuven, Belgium. At 22 weeks of gestation was attempted the fetoscopy bipolar cord occlusion of a TRAP fetus, part of MCDA TRAP sequence. The polyhydramnios from the pump twin was drained (2090 ml) for that purpose, the other on infused (950ml). There were good well-being of pump and noninvolved twin through the procedure. After management patient was in good condition. In 23rd weeks of gestation has iatrogenic PROM developed, without any signs of intrauterine infection. Ultrasound examination performed at 26th weeks of gestation showed a normal, concordant growth, normal amniotic fluid and normal artery and venous Doppler, the same as echocardiography examination. Antibiotic therapy was applied. Amniopatching was planned, but at 26 weeks of gestation patients developed uterine contractions together with increasing leucocytosis and CRP elevation. A first injection of Celestone was administered (12mg). Infants were delivered vaginally at the same day with birth weigh 760g and 895g. Preterm newborns were admitted to the neonatal intensive care unit and discharged from the hospital after three months treatment without any complications.