Monochorionic-Triamniotic Triplet Pregnancy Complicated by Twin Reversed Arterial Perfusion Sequence: Case Report and Literature Review
21 February 2017
21 April 2017
12 June 2017 (online)
Background Monochorionic-triamniotic pregnancies are rare and fraught with complications.
Case A case of monochorionic-triamniotic triplet pregnancy complicated by twin reversed arterial perfusion (TRAP) sequence is presented. The patient declined termination or selective fetal reduction. Triplet C was acardiac. At 24 weeks, triplet B developed polyhydramnios. At 30 weeks, polyhydramnios was seen in all three amniotic sacs, but without signs of fetal hydrops and with normal Doppler velocimetry measurements in the umbilical artery, middle cerebral artery, and ductus arteriosus of triplets A and B. At 322/7 weeks, the patient presented with preterm premature rupture of membranes and preterm labor. Two live male infants were delivered by cesarean delivery weighing 1,350 and 1,390 g, respectively; the acardiac fetus weighed 1,460 g. Pathology examination revealed a single placenta weighing1,250 g, with evidence of direct vascular connections between triplets A and C as well as between triplets A and B.
Conclusion Monochorionic-triamniotic triplet pregnancy with TRAP sequence is rare. Although the risk of complications is high, such pregnancies can be managed conservatively in select cases.
Keywordsmonochorionic - triplet pregnancy - acardiac fetus - twin-reversed arterial perfusion sequence
Guangxi Zhuang Autonomous Region Women and Children Care Hospital Ethics Committee approved the publication of this article.
- 1 Iwamoto H, Yoshida A, Suzuki H. , et al. Monochorionic triamniotic triplet pregnancies with assisted reproductive technology: two case reports. J Obstet Gynaecol Res 2010; 36 (04) 872-875
- 2 Ghulmiyyah LM, Perloe M, Tucker MJ, Zimmermann JH, Eller DP, Sills ES. Monochorionic-triamniotic triplet pregnancy after intracytoplasmic sperm injection, assisted hatching, and two-embryo transfer: first reported case following IVF. BMC Pregnancy Childbirth 2003; 3 (01) 4
- 3 Imaizumi Y. A comparative study of zygotic twinning and triplet rates in eight countries, 1972-1999. J Biosoc Sci 2003; 35 (02) 287-302
- 4 Argoti PS, Bebbington MW, Johnson A, Moise Jr KJ. Indirect pump: unique presentation of a monochorionic-triamniotic triplet gestation complicated by TRAP sequence and successfully managed with radiofrequency ablation of the acardiac fetus. Ultrasound Obstet Gynecol 2013; 42 (01) 115-117
- 5 Kirubamani NH. Successful pregnancy in triplet with trap sequence. Indian J Sci Technol 2012; 5 (09) 3304-3306
- 6 Bianchi DW, Crombleholme TM, D'Alton ME. Fetology: Diagnosis and Management of the Fetal Patient. 2nd ed. New York: McGraw-Hill Professional; 2010
- 7 Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990; 163 (03) 907-912
- 8 Sepulveda W, Wong AE, Bustos JC, Flores X, Alcalde JL. Acardiac fetus complicating a triplet pregnancy: management and outcome. Prenat Diagn 2009; 29 (08) 794-799
- 9 Kuran J, Niszczota C, Kolesnik A, Dangel JH. P23.15:Monochorionic triamniotic triplet pregnancy complicated by twin reversed arterial perfusion (TRAP) sequence. Ultrasound Obstet Gynecol 2012; 40 (Suppl. 01) 259
- 10 Søgaard K, Skibsted L, Brocks V. Acardiac twins: pathophysiology, diagnosis, outcome and treatment. Six cases and review of the literature. Fetal Diagn Ther 1999; 14 (01) 53-59
- 11 Bharadwaj MK, Mohana Priya N. A rare complication of monochorionic twin pregnancy: Twin-reversed arterial perfusion (TRAP) sequence. Med J Armed Forces India 2015; 71 (Suppl. 01) S114-S115
- 12 López-Pérez R, Lorente M, Martínez-Uriarte J. , et al. Twin-reversed arterial perfusion sequence in a triple monochorionic pregnancy with two direct pump fetuses results in significant cyclic Doppler waveform. Fetal Diagn Ther 2015; 37 (02) 157-160