Twin reversed arterial perfusion (TRAP) sequence in a monochorionic triplet pregnancy

Abstract

Twin reversed arterial perfusion syndrome is the most severe form of complication of a monozygotic twin pregnancy. Although not fully understood, the accepted theory of aetiology is an abnormal vascular connection between the vessels of the twins inside the placenta. The donor twin is a normally developed twin, also known as pumping twin, which supplies the blood supply to the mal developed twin. The mal developed twin is a mass of unorganised tissue; however, sometimes, little morphological differentiation can be observed. As the pumping twin has the supply of blood to the mal developed twin also, the risk of cardiac failure runs high in the pumping twin. As a result, most of these pregnancies result in an adverse outcome. Due to advancements in imaging and treatment, these cases are salvageable now, provided these are detected earlier. We are presenting a previously unreported case of triplet pregnancy with one normal fetus and two fetuses with TRAP physiology