Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/11280
Title: Twin-reversed arterial perfusion (TRAP) sequence: case reports and review of literature.
Authors: Hanafy, A
Peterson, C M
Affiliation: Department of Obstetrics and Gynaecology, Alice Springs Hospital, Northern Territory, Australia..
Issue Date: May-1997
Citation: The Australian & New Zealand journal of obstetrics & gynaecology 1997-05; 37(2): 187-91
Abstract: The twin reversed-arterial-perfusion (TRAP) sequence found in monozygotic twins is a consequence of primary or secondary cardiac development disruption and direct arterioarterial and venovenous placental anastomoses. Associated findings include the presence of a single umbilical artery (66%) and chromosomal abnormalities in the acardiac twin (33%). Morphological abnormalities in the acardiac twin are consistent with perfusion of tissues supplied by the common iliac and lower branches of the aorta with deoxygenated blood. The pump or donor twin may develop cardiac failure because of the anomalous perfusion circuit. Polyhydramnios is significantly associated with presence of renal tissue in the acardiac twin. An acardiac pump twin weight ratio (> 50%) is associated with the development of polyhydramnios and preterm labour. Identified high-risk factors for poor obstetrical outcome include: acardiac anceps, polyhydramnios, acardiac twin with ears, and pump twin cardiac failure. Management options include elective termination, observation (serial cardiotocography (CTG), ultrasonography and echocardiography) and selective nonsurgical interventions (indomethacin, digitalis, tocolysis). Additionally, surgical interventions (hysterotomy with selective delivery of the acardiac twin or ligation of the acardiac twin's umbilical cord), and ultrasound-guided embolization of the acardiac twin's umbilical artery with absolute alcohol, platinum coils, or thrombogenic coils have been reported. The most appropriate interventions for the various clinical presentations of this disorder are as yet undetermined, and conservative nonintervention is often appropriate. Long-term follow-up data on surviving pump twins are lacking. It is anticipated that centres with active study protocols for these conditions will best serve patient care and clinical research needs.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/11280
ISSN: 0004-8666
Type: Case Reports
Journal Article
Review
Subjects: Female
Fetus
Head
Humans
Oceanic Ancestry Group
Pregnancy
Syndrome
Triplets
Ultrasonography, Prenatal
Umbilical Arteries
Diseases in Twins
Heart Defects, Congenital
Twins, Monozygotic
Appears in Collections:NT Health digital library

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