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Introduction <p>Twin reversed arterial perfusion (TRAP) sequence is a rare complication in 1% of monochorionic twin pregnancies, occurring in approximately 1 in 35000 births. It occurs when one twin is normal and provides circulation to the other acardiac twin through placental vascular anastomoses, putting the normal twin at risk of cardiac failure and the whole pregnancy at risk of preterm labour due to polyhydramnios.</p> Observation <p>We report a case of a 30-year-old patient with a monochorionic diamniotic twin pregnancy diagnosed with TRAP sequence at 22 weeks. Following radiofrequency ablation (RFA), a rare complication of residual flow was noted in the acardiac twin. After repeated amnioreduction, spontaneous cessation of flow was observed, allowing the pregnancy to continue to 36 + 6 weeks delivering a healthy pump twin without further complications.</p> Conclusion <p>This case highlights the effectiveness of RFA combined with amnioreduction, progesterone support and close monitoring in managing TRAP sequence. It demonstrates the potential for spontaneous resolution of residual flow in the acardiac twin, contributing to favourable maternal and neonatal outcomes.</p>

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Twin reversed arterial perfusion sequence: managing a rare complication

  • 期刊论文

  • 发表日期：

    2025年9月15日

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  • Sakshi Aggarwal,
  • Krishna Agarwal,
  • Ila Sehrawat,
  • Ayushi Sinha

摘要

Introduction

Twin reversed arterial perfusion (TRAP) sequence is a rare complication in 1% of monochorionic twin pregnancies, occurring in approximately 1 in 35000 births. It occurs when one twin is normal and provides circulation to the other acardiac twin through placental vascular anastomoses, putting the normal twin at risk of cardiac failure and the whole pregnancy at risk of preterm labour due to polyhydramnios.

Observation

We report a case of a 30-year-old patient with a monochorionic diamniotic twin pregnancy diagnosed with TRAP sequence at 22 weeks. Following radiofrequency ablation (RFA), a rare complication of residual flow was noted in the acardiac twin. After repeated amnioreduction, spontaneous cessation of flow was observed, allowing the pregnancy to continue to 36 + 6 weeks delivering a healthy pump twin without further complications.

Conclusion

This case highlights the effectiveness of RFA combined with amnioreduction, progesterone support and close monitoring in managing TRAP sequence. It demonstrates the potential for spontaneous resolution of residual flow in the acardiac twin, contributing to favourable maternal and neonatal outcomes.