Twin room of reverse arterial perfusion (TRAP) sequence is a rare complication of multiple pregnancy caused by defects in the early embryogenesis. The pump twin delivers the Acardiac recipient twin with blood, and although the pump twin is usually structurally normal, congenital anomalies is sometimes reported. We report a unique case twin vice versa arterial perfusion sequence with a prenatal diagnosis of the VACTERL Association in survivors pump twins.
A 24-year-old Caucasian woman on 11 weeks pregnancy with a Monochorionic Monoamniotic twin pregnancy presented. A reverse arterial River was apparently normal recorded on a Doppler twins at the smaller, grossly abnormal twin imaging study from the larger and Diagnostics twin vice versa arterial perfusion sequence was made. Heart activity was twin 16 weeks pregnancy undetectable in the receiver. For more detailed assessment to 18 weeks gestation revealed multiple congenital anomalies of the survivors pump twin in accordance with a diagnosis of VACTERL Association. A live children girl by elective caesarean section at 39 weeks came. She underwent extensive surgery with below normal development in the age of two.
The coexistence of two rare and complex conditions in this unique case raises interesting questions about the role of the early shortcomings in embryogenesis and their subsequent effects on fetal development. In this case also underlines the importance of the prenatal diagnosis of major congenital anomalies of plan treatment to reduce morbidity and aid the survival of affected children.
