Bhubaneswar, Odisha, Feb 09: In a remarkable demonstration of advanced prenatal and fetal medicine care, Ankura Hospital for Women and Children, Bhubaneswar, successfully managed a rare and high-risk twin pregnancy diagnosed with Twin Reversed Arterial Perfusion (TRAP) sequence, ensuring a favourable outcome for the healthy twin. The complex case was expertly handled under the care of Dr Rama Manjari Naik, Consultant Fetal Medicine Specialist.
TRAP sequence is an exceptionally rare complication seen in monochorionic twin pregnancies, occurring in approximately 1–2.6% of monochorionic twin gestations and about 1 in 35,000 pregnancies overall. The condition poses significant risk to the healthy “pump twin,” making early diagnosis and specialised care critical.
Understanding the Condition
The pregnancy involved monochorionic twins, where both fetuses share a single placenta. In TRAP sequence, one twin—known as the acardiac twin—develops without a functional heart and survives by drawing blood from the healthy twin through abnormal placental vascular connections. This reversed blood flow places immense strain on the pump twin’s heart and can result in heart failure, preterm birth, or fetal loss if not managed appropriately.
Early Diagnosis and Expert Evaluation
The condition was detected during a routine antenatal ultrasound, which revealed one normally developing fetus alongside a severely malformed fetus with no detectable cardiac activity. Detailed Doppler studies confirmed reversed arterial blood flow, establishing the diagnosis of TRAP sequence.
“Early identification through advanced imaging played a crucial role in guiding clinical decisions and monitoring,” said Dr Rama Manjari Naik, Consultant Fetal Medicine at Ankura Hospital, who diagnosed and managed the case.
Counselling, Monitoring and Timely Intervention
Following extensive counselling, the parents were informed about the risks, prognosis, and available fetal therapy options, including radiofrequency ablation, laser coagulation, and bipolar cord occlusion. After careful consideration, the family chose to continue the pregnancy under close medical supervision.
The pregnancy was monitored on a weekly basis with detailed assessments of fetal growth, amniotic fluid volume, and Doppler parameters. Special attention was given to the size of the acardiac twin, a critical indicator of potential cardiac strain on the healthy fetus.
At 36 weeks and 4 days of gestation, Doppler abnormalities were noted, prompting a planned lower segment caesarean section (LSCS). The healthy twin was delivered safely with a favourable outcome.
Histopathological examination of the acardiac mass confirmed the presence of cartilage, bone tissue, skeletal muscle, and epithelial lining, validating the antenatal diagnosis.
A Message of Hope
This rare case highlights the importance of early diagnosis, specialised fetal medicine expertise, and multidisciplinary care in managing complex and high-risk pregnancies. Ankura Hospital for Women and Children houses a well-established fetal medicine department equipped with advanced technology, offering comprehensive prenatal diagnostic and monitoring services in Odisha.
“With advancements in prenatal imaging and fetal medicine, outcomes that were once considered unattainable are now possible, offering renewed hope to families facing rare and high-risk twin pregnancies,” concluded Dr Rama Manjari Naik.