TWIN PREGNANCY WITH TRAP SEQUENCE COMPLICATED WITH RETROPLACENTAL HEMATOMA - A CASE REPORT.

Twin reversed arterial perfusion (TRAP) sequence is a rare (1/35.000 pregnancies) and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). The normal twin has a high mortality rate (50- 70%), especially due to congestive heart failure. We report on the case of a IIG IIIP 33 year-old patient who was referred to our institution form another service with the initial diagnosis of multiple pregnancy with one dead twin. Ultrasound revealed 24 gestational weeks intrauterine biamniotic monochorionic twin pregnancy with TRAP sequence and polyhydramnios. Therapeutic amniocentesis was performed for polyhydramnios, evacuating 500 ml of amniotic fluid. A fetoscopic intervention was decided, with the occlusion of the umbilical cord of the acardiac twin, followed by the evacuation of another 700 ml amniotic fluid. The patient was readmitted to our institution at 34 gestational weeks for preterm premature rupture of membranes and vaginal bleeding. Ultrasound revealed intrauterine growth restriction of the living twin, corresponding to 30 gestational weeks and retroplacentar hematoma, reaching 8,5/5 cm. The patient gave birth through cesarean section to a living female fetus, weighing 1480 g, Apgar score 6, 7, 8 at 1, 2 and respectively 5 minutes. In conclusion, TRAP sequence is a rare entity, requiring early diagnosis and careful ultrasound monitoring, in order to select the best management option for the pump twin. To the best of our knowledge, this is the first case reporting a twin pregnancy with TRAP sequence complicated with retroplacentar hematoma. [ABSTRACT FROM AUTHOR]