The management of monochorionic pregnancy with twin reversed arterial perfusion

Twin reversed arterial perfusion (TRAP) is a specific complication of monochorionic multiple pregnancy. It has the incidence of approximately 1:9500 pregancies or 2.5 % monochorionic twins. The main one for nowadays is hemodynamic theory that suggests that severely malformed acardiac fetus lacks most organs and particularly heart and grows up because of the artery-to-artery anastomose that shunts blood from another normally developed pump fetus system. The perinatal mortality for pump twin rises to 70 %. There are different surgical approaches that aimed in acardiac twin blood cessation in order to improve the outcome for pump twin. At the same time today we can provide highly effective ultrasound monitoring for pump twin that can exclude fetal intervention and organize safe conservative option for the pump twin. The paper represents the comparative analysis for conservative and fetal intervention managements and shares our descriptive analysis of triplet pregnancies with twin reversed arterial perfusion sequence.

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