Spontaneous triplet pregnancy and trap sequence, case report

Engin Yıldırım

doi:10.1186/s12884-019-2484-3

Abstract

BackgroundSpontaneous multiple pregnancies are rare, and the incidence of spontaneous triplet pregnancy is about 1/4000. TRAP (Twin Reversed Arterial Perfusion) sequence has acardiac foetus with non-viable multiple anomalies, and there is a pump foetus which feeds this foetus with placental anastomoses. TRAP sequence phenomena is quite rare in triplet pregnancies.Case presentationThe patient who applied to our clinic was 30 years old. Monochorionic diamniotic triplet pregnancy was detected by ultrasonographic examination. First amniotic sac had one foetus (Foetus A). Ultrasonographic evaluation of Foetus A revealed gestational age of 31 weeks, adequate amniotic fluid and no fetal structural anomalies. The second amniotic sac contained 2 foetuses and polyhydromnios. Ultrasonic measurements of Foetus B were consistent with 32 weeks gestational age. Color flow doppler indicated Foetus B was the pump foetus. Foetus C was an acardiac foetus with no sonographic visualization of cranium, thoracic organs or extremities, but abdominal circumference consistent with 28 weeks. Pregnancy was followed conservatively and evaluated regularly by ultrasonography twice a week. When prolonged bradycardia was detected in fetus B at 35 4/7 weeks, emergency cesarean section was performed. Two healthy fetuses weighing 2 kg were delivered each with an 8/10 APGAR score (Appearance, Pulse, Eye Insertion, Activity, Respiration).ConclusionThis case was managed without any invasive procedures and demonstrates that treatment of TRAP sequence cases can be individualized considering clinical conditions, the size of the acardia twin and extent of placental venous anastomoses.

Highlights

Spontaneous multiple pregnancies are rare, and the incidence of spontaneous triplet pregnancy is about 1/4000
This case was managed without any invasive procedures and demonstrates that treatment of Twin reversed arterial perfusion (TRAP) sequence cases can be individualized considering clinical conditions, the size of the acardia twin and extent of placental venous anastomoses
Ultrasound did not reveal the cranium, thoracic organs and extremities of Foetus C; abdominal circumference was measured at 240.72 mm, indicating that the foetus was at 28 weeks of gestation

Summary

Background

In recent years, emerging of developments in reproductive techniques, there is an increase in the prevalence of multiple pregnancies. Our ultrasonographic evaluations indicated a monochorionic diamniotic triplet pregnancy at first visit. No structural anomalies were detected in the ultrasonographic organ scan of Foetus A. Ultrasonographic evaluations indicated a normal organ scan for Foetus B, but polyhydroamniosis was detected in the amniotic sac. Ultrasound did not reveal the cranium, thoracic organs and extremities of Foetus C; abdominal circumference was measured at 240.72 mm, indicating that the foetus was at 28 weeks of gestation. An evaluation of Foetus C’s umbilical cord flow showed two arteries and a single vein. A foetal magnetic resonance (MR) assessment was performed for Foetus C This examination showed no extremities belonging to Foetus C and indicated clearly that the placenta was monochorionic. The patient’s non-stress test findings were normal and the pump foetus’s (Foetus B) examination did not indicate cardiac failure; the patient was treated with betamethasone two times.

Discussion

Conclusion