Published: 2018-04-25

Twin Reversed Arterial Perfusion (TRAP) Syndrome or acardiac twin: a case report in Madagascar

Lyn Z. A. Rabetsimamanga, Hary F. Rabarikoto, Maheriandrianina F. V. Rajaonarivony, Setriny M. Ravoavy, Hery R. Andrianampanalinarivo


TRAP syndrome is a rare complication of monochorionic twin pregnancy. It is characterized by the association of an acardiac twin with a healthy twin. The acardiac twin is a parasite who put the healthy twin at high risk of cardiac failure. We report a case in a 25-year-old Malagasy woman, primigravida, who had a consultation at gestational week 31 for significant dyspnea and a threat of premature delivery. Ultrasound scans discovered an acute polyhydramnios, fetus with anasarca and low cardiac activity, and a para-fetal mass. She gives birth to a male newborn and an acardiac twin without head an upper body. The first twin died short time after birth.


Acardiac twin, Madagascar, Twin reversed arterial perfusion syndrome, Ultrasound

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Tayal T, Kaul A. Intrafetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Successful Outcome. The Journal of Obstetrics and Gynecology of India. 2012;62(S1):S43-S45.

Guigue V, Schwetterle F, Arbez-Gindre B. The case of a nacardiac headless twin, review of the litterarure. J Gynécol Obstet α Biol Reprod. 2007;36:293-7.

Ferianec V, Redecha M, Papcun P, Križko M Jr, Hollý I, Holomáň K. Successful ablation of acardiac twin with Histoacryl. Taiwan J Obstet Gynecol. 2016;55(1):109-11.

Nigam A, Agarwal R, Saxena P, Barla J. Acardiac anceps: a rare congenital anomaly. BMJ Case Rep. 2014.

Anca FA, Negru A, Mihart AE, Grigoriu C, Bohîlțea RE, Șerban A. Special forms in twin pregnancy - ACARDIAC TWIN/ Twin reversed arterial perfusion (TRAP) sequence. Journal of Medicine and Life. 2014;8(4):517-22.

Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol. 1990;163:907-12.

Kalyani R, Bindra MS. Twin Reversed Arterial Perfusion Syndrome (TRAP or Acardiac Twin)-A Case Report. J Clin Diagn Res. 2014;8(1):166-7.

Hecher K, Hackeloer BJ, Ville Y. Umbilical cord coagulation by operative microendoscopy at 16 weeks’ gestation on acardiac twin. Ultrasound Obstet Gynécol. 1997;10:130-2.