Twin-Reversed Arterial Perfusion Sequence/Syndrome (TRAP): An Insight into the Ultrasonographic Features for Prenatal Diagnosis and Review of Literature

We present two case reports of twin reversed arterial perfusion sequencea rare type of twin-twin transfusion syndrome wherein there is abnormal development of one fetus which derives its blood supply from the normal fetus. It is present in cases of monochorionic twin pregnancies and is also known as chorangiopagusparasiticus. Prompt diagnosis and intervention are needed to prevent the death of the normal twin. We discuss the importance of diagnosing this entity. Conflict of Interest: None declared This article has been peer reviewed. Article Submitted on: 1 February 2016 Article Accepted on: 20August 2016 Funding Sources: None Declared Correspondence to: Dr Mohd Ilyas Address: Department of Radiodiagnosis and Imaging, Government Medical College Jammu, Jammu and Kashmir, India Email: [email protected] Cite this article: Ilyas M, Bhat A, Dev G. Twinreversed arterial perfusion sequence/syndrome: an insight into the ultrasonographic features for prenatal diagnosis and review of literature. J Pioneer Med Sci 2016; 6(4):122-126 cytomegalovirus, and herpes simplex) profile were within normal range. Ultrasonography (USG) with color Doppler found a live fetus with a biparietal diameter (BPD) and femur length (FL) corresponding to the gestational age of 19 weeks 2 days and another heterogeneous mass in the amniotic cavity. On careful examination, the mass was seen connected to the normal fetus via an umbilical artery and consisted of fetal liver and gut loops surrounded by membranes with absent fetal head, thorax and upper limbs (Fig. 1a). Color Doppler study revealed high pulsatility index (PI) and resistivity index (RI) of the involved umbilical arteries (Fig. 1b and 1c). Single anterior uterine wall placenta was visible. The diagnosis of twin pregnancy with one normal fetus and another acardiac acephalic twin was made with a demonstration of TRAP on color Doppler and patient was sent to obstetrics service for further management.