Successful pregnancy in triplet with trap sequence

N Hephzibah Kirubamani

doi:10.17485/ijst/2012/v5i9.14

Abstract

A case report is presented on twin reversal arterial perfusion in Triplet. The acardiac twin usually grows along with the pump twin, but due to inadequate perfusion it is unable to develop the structures necessary for life. In this condition zero intervention will be associated with almost 100% mortality rate of one or all fetuses. Hence in utero therapy was decided for our patient. In utero thermogeneic coil was applied on the blood vessel to Acardiac monster. As there was reanastomosis, again second coil was applied. Subsequently, the blood supply to Acardiac was totally cut off. The pregnancy was scanned weekly thereafter and both fetuses maintained good growth without any evidence of cardiac decompensation in the pump twin. The acardius remained stable in size. As patient developed hydrominios, Amnioreduction was done further to prevent preterm labour. Expectant management and dexamethasone courses weregiven. At 35 weeks of gestation and ultrasound revealed redistribution of arterial blood flow in the pump twin. In view of the risk of further haemodynamic instability of the pump twin, a Caesarean section was done and delivered two alive babies weighing 2.4 kg and 2.6 Kg along with mumpified acardiac fetus.Since blood supply to acardiac twin was interrupted by 19 weeks our goal to get other two babies alive were achieved. This is the first case reported from Government R.S.R.M. Lying-in Hospital, Chennai, India.

Highlights

Twin reversed arterial perfusion is a rare complication of monochorionic twin pregnancies, involving an acardiac twin whose structural defects are incompatible with life, and an otherwise normal "pump" twin
It is apparent that deoxygenated blood from the pump twin is perfused to the acardiac twin is called Perfused Twin and it is a true parasite
Pump twin Structurally the pump twin is generally normal, but due some of the related problems including the rapid growth of the acardiac twin, polyhydramnios, and heart failure due to high output and there is a high mortality rate for the pump twin

Summary

Introduction

Twin reversed arterial perfusion is a rare complication of monochorionic twin pregnancies, involving an acardiac twin whose structural defects are incompatible with life, and an otherwise normal "pump" twin. The acardiac twin grows along with the pump twin, but due to inadequate perfusion it is unable to develop the structures necessary for life, and presents with dramatic deformities. On 17th Jan when fetus was 17 week gestation under Scan guidance an in utero thermogeneic coil was applied on the blood vessel to Acardiac monster (Fig. 2).

Results

Conclusion