ArticleDiagnostics (Basel, Switzerland)2023
"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.
Article in Diagnostics (Basel, Switzerland), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 6 citations in OpenAlex.
- Early First-Trimester Diagnosis of Thoracopagus Conjoined Twins with a Shared Cardiac Structure.Diagnostics (Basel, Switzerland) · 2026Article
- Managing TRAP Sequence Conservatively: A Case Report of Full-Term Pregnancy With Favorable Outcome.Clinical case reports · 2026Article
- Fetal brain injury in the pump twin of a TRAP sequence with favorable postnatal outcome: a case report.BMC pregnancy and childbirth · 2025Article
- Individualized intervention and growth dynamics assessment in TRAP sequence with conjoined twins based on radiofrequency ablation.BMC pregnancy and childbirth · 2025Article
- Twin Reversed Arterial Perfusion Sequence Diagnosed Late in the Third Trimester: A Case Report and Literature Review.Clinical case reports · 2025Article
- Rare Case of Twin Reversed Arterial PerfusionAJP reports · 2024Article
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Authors and funding
12 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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