Twin reversed arterial perfusion sequence managed by bipolar cord coagulation and amniopatch: Case report.

Abstract

Introduction and importanceTwin Reversed Arterial Perfusion (TRAP) Sequence is a rare condition that occurs in monochorionic twin pregnancies, resulting in the coexistence of a normal “pump” twin and an acardiac twin. Indonesia is implementing fetal therapy centers that are starting to treat fetal cases such as TRAP Sequence.Case presentationAn 18 years old pregnant woman with monochorionic diamniotic pregnancy was detected by ultrasonographic examination. A live fetus with normal fetal heart rate estimated fetal weight was 661 g, and consistent with 25 w gestational age. Additionally, an acardiac twin with polyhydramnios and EFW of 1829 g. Bipolar cord coagulation, amniopatch, and amnioinfusion were performed. The patient's condition was stable and managed closely.Clinical discussionThis is the first procedure reported in Indonesia for TRAP sequence case. It reduces cardiac strain on the pump twin and increases the chance of survival.ConclusionThe patient was diagnosed with TRAP Sequence and bipolar cord coagulation to interrupt blood supply to the non-viable twin, amniopatch with autologous platelet concentrate followed by cryoprecipitate amnioinfusion were reported for the first time in Indonesia.