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DOI: 10.1055/a-2525-9498
TRAP (Twin Reversed Arterial Perfusion) Sequenz im dritten Trimenon
TRAP (Twin Reversed Arterial Perfusion) Sequence in the Third Trimester
Zusammenfassung
Die Twin Reverse Arterial Perfusion (TRAP) Sequenz ist ein komplexes Fehlbildungssyndrom bei monochorialen Mehrlingsschwangerschaft, die durch vaskuläre Anastomosen und partielle oder vollständige Fehlbildung des Herzens und der Extremitäten eines Feten charakterisiert ist. Dies führt zu einer hämodynamischen Abhängigkeit des parasitären Zwillings (Akzeptor) vom „Pump-Zwilling“ (Donor). Ziel des Managements ist, die Überlebenschancen des Pump-Zwillings zu maximieren. Der optimale Zeitpunkt für die Behandlung mittels Radiofrequenz-Ablation oder ultraschallgesteuerter Laserkoagulation ist unklar, internationale wird häufig eine Intervention vor der 16. SSW empfohlen. Wir berichten über die Entbindung bei einer bis dahin nicht diagnostizierten und damit im klinischen Verlauf besonderen monochorial-monoamnioten Geminischwangerschaft in der 34. SSW in unserem Perinatalzentum und zeigen die beeindruckende Maximalausprägung einer untherapierten TRAP-Sequenz.
Abstract
The twin reversed arterial perfusion (TRAP) sequence is a complex and rare malformation syndrome that can occur in monochorionic twin pregnancies. It is characterized by vascular anastomoses and partial or total malformation of the heart and extremities of one of the fetuses. This leads to a hemodynamic dependence of the “parasitic” fetus (acceptor) from the “pump fetus” (donor). The therapeutic goal is to maximize the survival chances of the pump fetus. Although the optimal time for the therapeutic intervention, using radiofrequency ablation or ultrasound laser coagulation, is not clear yet, it is internationally recommended to be performed before gestational week 16. We present the case of an undiagnosed und therefore unusual monochorionic monoamniotic pregnancy in gestational week 34, in our perinatal center and demonstrate the impressive maximal expression of an untreated TRAP sequence.
Publication History
Received: 01 June 2024
Accepted after revision: 15 January 2025
Article published online:
14 February 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
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