Monochorionic-triplet pregnancy with twin reversed arterial perfusion syndrome


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background: Monochorionic-tripletpregnancies are rare clinical cases and thisplacentation type concurrent with congenital malformations in one of the fetuses causes difficulties in choosing obstetric tactics. Case report: The paper describes three clinical cases of monochorionic-triplet pregnancy with twin reversed arterial perfusion syndrome. In one case, the pregnancy occurred after in vitro fertilization and transfer of two five-day embryos, which made it difficult to timely diagnose. The pregnancy was spontaneous in the other two cases. Two other pregnancies were spontaneous. All pregnancy cases were terminated due to the high risk of adverse obstetric complications. Pathological examination of the post-abortion material confirmed the prenatally established diagnosis. A molecular genetic study of the zygosity of the twins revealed that they were monozygotic. Conclusion: Twin reversed arterial perfusion syndrome is associated with the high risk of adverse perinatal outcomes and the high rate of diagnostic errors for twins. In triplet pregnancies, the prognosis is poorer due to the high incidence of obstetric complications.

Full Text

Restricted Access

About the authors

Oksana V. Pribushenya

"Mother and Child" Republican Research and Practical Center, Ministry of Health of the Republic of Belarus

Email: pribushenya@yandex.ru
MD, PhD, Head of the Scientific Laboratory for Medical Genetics

Nastassia A. Lazarevich

"Mother and Child" Republican Research and Practical Center, Ministry of Health of the Republic of Belarus

Email: lazikn@mail.ru
Researcher at the Scientific Laboratory for Medical Genetics

References

  1. Mazhar S.B., Rahim F., Furukh T. Fetomaternal outcome in triplet pregnancy. J. Coll. Physicians Surg. Pak. 2008; 18(4): 217-21.
  2. Garg P., Abdel-Latif M.E., Bolisetty S., Bajuk B., Vincent T., Lui K. Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in NSW and the ACT, Australia (1994-2005). Arch. Dis. Child. Fetal Neonatal Ed. 2010; 95(1): F20-24. https://dx.doi.org/10.1136/adc.2009.157701.
  3. Pereira N., Cozzubbo T., Cheung S., Rosenwaks Z., Palermo G.D., Neri Q.V. Identifying maternal constraints on fetal growth and subsequent perinatal outcomes using a multiple embryo implantation model. PLoS One. 2016; 11(11): e0166222. https://dx.doi.org/10.1371/journal.pone.0166222.
  4. Sunderam S., Kissin D.M., Zhang Y., Folger S.G., Boulet S.L., Warner L. et al. Assisted reproductive technology surveillance - United States, 2016. MMWR Surveill. Summ. 2019; 68(4): 1-23. https://dx.doi.org/10.15585/mmwr.ss6804a1.
  5. De Geyter C., Calhaz-Jorge C., Kupka M.S., Wyns C., Mocanu E., Motrenko T. et al. ART in Europe, 2015: results generated from European registries by ESHRE. Hum. Reprod. Open. 2020; 2020(1): hoz038. https://dx.doi.org/10.1093/hropen/hoz038.
  6. Iwamoto H., Yoshida A., Suzuki H., Wyns C., Mocanu E., Motrenko T. et al. Monochorionic triamniotic triplet pregnancies with assisted reproductive technology: two case reports. J. Obstet. Gynaecol. Res. 2010; 36: 872-5. https://dx.doi.org/10.1111/j.1447-0756.2010.01235.x.
  7. Петрушко М.П., Пиняева В.И., Правдина С.С., Подуфалий В.В., Чуб Н.Н. Монозиготная моноамниотическая тройня после переноса одной бластоцисты (клинический случай). Проблемы репродукции. 2013; 3: 47-8.
  8. Калинина Е.А., Владимирова И.В., Сухих Г.Т. Монохориальная триамниотическая тройня в программе ВРТ: клиническое наблюдение. Акушерство и гинекология. 2016; 4: 151-3. https://dx.doi.org/10.18565/aig.2016.4.151-153.
  9. Прибушеня О.В., Хурс О.М., Котова С.А., Рыбакова В.И., Цыбовский И.С. Определение зиготности при многоплодии. Обзор литературы и собственные клинические наблюдения самопроизвольно наступивших беременностей тройней. Пренатальная диагностика. 2016; 15(4): 318-27.
  10. Imaizumi Y.F. A comparative study of zygotic twinning and triplet rates in eight countries, 1972-1999. J. Biosoc. Sci. 2003; 35(2): 287-302. https://dx.doi.org/10.1017/S002193003002876.
  11. Wong A.E., Sepulveda W. Acardiac anomaly: current issues in prenatal assessment and treatment. Prenat. Diagn. 2005; 25(9): 796-806. https://dx.doi.org/10.1002/pd.1269.
  12. Diehl W., Hecher K. Selective cord coagulation in acardiac twins. Semin. Fetal Neonatal Med. 2007; 12(6): 458-63. https://dx.doi.org/10.1016/j.siny.2007.06.008.
  13. Kaliany R., Bindra M.S. Twin reversed arterial perfusion syndrome (TRAP or acardiac twin) - a case report. J. Clin. Diagn. Res. 2014; 8(1): 166-7. https://dx.doi.org/10.7860/JCDR/2014/7012.3965
  14. Moore T.R., Gale S., Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am. J. Obstet. Gynecol. 1990; 163(3): 907 12. https://dx.doi.org/10.1016/0002-9378(90)91094-s
  15. Прибушеня О.В., Новикова И.В., Семенчук В.Л., Лазаревич А.А., Белуга М.В. Синдром обратной артериальной перфузии близнецов: медико-генетическое консультирование, акушерская тактика и методы коррекции. Пренатальная диагностика. 2015; 14(3): 215-23
  16. Petersen B.L., Broholm H., Skibsted L., Graem N. Acardiac twin with preserved brain. Fetal Diagn. Ther. 2001; 16(4): 231-3. https://dx.doi.org/10.1159/000053916.
  17. Malinowski W., Szwalski J. Ciaza trojacza jednokosmowkowa dwuowodniowa powikiana wystapieniem zespoiu "odwroconego kierunku przepiywu krwi". Badanie patomorfologiczne piodu "bez serca" i popiodu. [Monochorionic, diamniotic triplet pregnancy complicated by twin reversed arterial perfusion sequence. Postpartum autopsy of placenta and acardiac fetus]. Ginekol. Pol. 2004; 75(11): 863-8.
  18. Pan P., Luo G., Tang L., Rolle J.D., Qin Y., Zeng Q. et al. Monochorionic-triamniotic triplet pregnancy complicated by twin reversed arterial perfusion sequence: case report and literature review. AJP Rep. 2017; 7(2): e106-e110. https://dx.doi.org/10.1055/s-0037-1603917.
  19. Kobori S., Toshimitsu M., Nagaoka S., Murotsuki J. A case of monochorionic-triamniotic triplet pregnancy with TRAP sequence successfully treated with radiofrequency ablation with a parallel circuit consisting of anastomosed blood vessels between the direct pump fetus and the indirect pump fetus. Case Rep. Obstet. Gynecol. 2019; 2019: 5319028. https://dx.doi.org/10.1155/2019/5319028.
  20. Yildirim E. Spontaneous triplet pregnancy and trap sequence, case report. BMC Pregnancy Childbirth. 2019; 19(1): 328. https://dx.doi.org/10.1186/s12884-019-2484-3.
  21. Sepulveda W., Wong A.E., Bustos J.C. Flores X., Alcalde J.L. Acardiac fetus complicating a triplet pregnancy: management and outcome. Prenat. Diagn. 2009; 29(8): 794-9. https://dx.doi.org/10.1002/pd.2291.
  22. Argoti P.S., Bebbington M.W., Johnson A., Moise K.J. Jr. Indirect pump: unique presentation of a monochorionic-triamniotic triplet gestation complicated by TRAP sequence and successfully managed with radiofrequency ablation of the acardiac fetus. Ultrasound Obstet. Gynecol. 2013; 42(1): 115-7. https://dx.doi.org/10.1002/uog.12354.
  23. Lopez-Perez R., Lorente M., Martinez-Uriarte J., Rivero I.M., Garcia-Izquierdo O., Jodar M.A. et al. Twin-reversed arterial perfusion sequence in a triple monochorionic pregnancy with two direct pump fetuses results in significant cyclic Doppler waveform. Fetal Diagn. Ther. 2015; 37(2): 157-60. https://dx.doi.org/10.1159/000361019.
  24. Takano M., Nakata M., Rikitake T., Nagasaki S., Hayata E., Morita M. Successful use of fetoscopic laser surgery as treatment for a monochorionic-triamniotic triplet pregnancy complicated by twin-reversed arterial perfusion sequence and severe selective fetal growth restriction: a case report. J. Obstet. Gynaecol. Res. 2019; 45(8): 1584-7. https://dx.doi.org/10.1111/jog.13994.
  25. Костюков К.В., Гладкова К.А., Тетруашвили Н.К. Тактика ведения беременности при синдроме обратной артериальной перфузии. Акушерство и гинекология. 2018; 11: 44-9. [Kostyukov K.V., Gladkova K.A., Tetruashvili N.K. Pregnancy management in patients with reverse arterial perfusion syndrome. Obstetrics and Gynecology. 2018; 11: 44-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.11.44-49.
  26. Takahashi Y., Iwagaki S., Chiaki R., Asai K., Matsui M., Kawabata I. Ultrasonic identification of pump twin by dual-gate Doppler in a monochorionic-triamniotic triplet twin reversed arterial perfusion sequence before preventative radiofrequency ablation: a case report. J. Med. Ultrason. (2001). 2018; 45(1): 185-7. https://dx.doi.org/10.1007/s10396-017-0792-7.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies