“The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature
The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometime...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-09-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/19/3109 |
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| author | Pierpaolo Nicolì Gianluca Raffaello Damiani Maria Gaetani Miriam Dellino Amerigo Vitagliano Antonio Malvasi Gerardo Cazzato Eliano Cascardi Andrea Marzullo Raffaello Alfonso Ettore Cicinelli Antonella Vimercati |
| author_facet | Pierpaolo Nicolì Gianluca Raffaello Damiani Maria Gaetani Miriam Dellino Amerigo Vitagliano Antonio Malvasi Gerardo Cazzato Eliano Cascardi Andrea Marzullo Raffaello Alfonso Ettore Cicinelli Antonella Vimercati |
| author_sort | Pierpaolo Nicolì |
| collection | DOAJ |
| description | The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50–55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence. |
| first_indexed | 2024-03-10T21:47:09Z |
| format | Article |
| id | doaj.art-e759db8b922d4ce7bd1823e17c70c547 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T21:47:09Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-e759db8b922d4ce7bd1823e17c70c5472023-11-19T14:14:54ZengMDPI AGDiagnostics2075-44182023-09-011319310910.3390/diagnostics13193109“The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of LiteraturePierpaolo Nicolì0Gianluca Raffaello Damiani1Maria Gaetani2Miriam Dellino3Amerigo Vitagliano4Antonio Malvasi5Gerardo Cazzato6Eliano Cascardi7Andrea Marzullo8Raffaello Alfonso9Ettore Cicinelli10Antonella Vimercati11Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyPrivate Practice Gynecologist, 70124 Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Medical Sciences, University of Turin, 10124 Turin, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyDepartment of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, ItalyThe Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50–55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence.https://www.mdpi.com/2075-4418/13/19/3109monochorionic twin pregnancytrap sequence3D ultrasoundtransvaginal ultrasoundearly diagnosis |
| spellingShingle | Pierpaolo Nicolì Gianluca Raffaello Damiani Maria Gaetani Miriam Dellino Amerigo Vitagliano Antonio Malvasi Gerardo Cazzato Eliano Cascardi Andrea Marzullo Raffaello Alfonso Ettore Cicinelli Antonella Vimercati “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature Diagnostics monochorionic twin pregnancy trap sequence 3D ultrasound transvaginal ultrasound early diagnosis |
| title | “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature |
| title_full | “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature |
| title_fullStr | “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature |
| title_full_unstemmed | “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature |
| title_short | “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature |
| title_sort | the strange case of dr pump and mr acardiac the twin reversed arterial perfusion trap sequence in two monochorionic monoamniotic mcma twin pregnancies diagnosis prognosis and management review of literature |
| topic | monochorionic twin pregnancy trap sequence 3D ultrasound transvaginal ultrasound early diagnosis |
| url | https://www.mdpi.com/2075-4418/13/19/3109 |
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