Successful first trimester intrauterine treatment with alcohol in a case of acardiac twin pregnancy

Twin reversed arterial perfusion (TRAP) sequence is a serious condition of monochorionic twin pregnancy. It is an extremely rare anomaly, occurring with a reported incidence of 1 in 35000 deliveries, 1 in 100 monozygotic twins and 1 in 30 monozygotic triplets. This condition is associated high risk of perinatal death of the pump twin due to cardiac failure and polyhidramnios may induce preterm birth.
Several methods have been proposed for intrauterine treatment of acardiac twin pregnancy and selective reduction of the acardiac twin was recently reported to be minimally invasive and effective for intrauterine treatment of acardiac twin pregnancy. First trimester treatment of TRAP sequence is controversies with higher incidence of procedure related complications. We present a case of TRAP sequence that has been managed by intrauterine treatment with alcohol injection at 12 weeks of gestation. Prophylactic intervention at 12 weeks of gestation may be resulted with higher survival rate if the early procedure could prevent fetal loss of pump twin before 16 weeks.
First trimester prophylactic intervention could be recommended patient with TRAP sequence. Alcohol ablation can be performed in medical center unless more sophisticated methods as invasive procedure are not available.

Keywords

Acardiac twin, twin pregnancy, intrauterine intervention

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	Figure 1 Acardiac fetus after delivery