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Majalah Obstetri & Ginekologi

ISSN 0854-0381

Vol. 16 / No. 3 / Published : 2001-01

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Original Article :

A case of trap sequence at dr. soetomo general hospital

Author :

  1. Frans OH Prasetyadi*1
  1. -

Abstract :

We reported a case of TRAP sequence in Surabaya, which was the first found and managed locally without access to an established fetal surgery facility. A 26 year-old, G2P0A1 female was referred at 16 week’s gestation. Previous sonography examination revealed a twin pregnancy; one of the fetuses had died in utero. The demised fetus had no detectable skull and showed evidence of beginning fetal hydrops. Repeated sonography examinations demonstrated a mono-amniotic twin pregnancy. Twin A had no structural anomaly consistent with 16 weeks of gestational age. Grossly abnormal anatomy was noted in twin B with no cardiac structures; absence of a fetal skull, spine ending abruptly in the cervical region, 2 vessels in the cord, and fetal hydrops. The amniotic fluid amount was slightly increased. Initially, expectant management was on the basis of the much smaller size of the acardiac twin compared to the normal one. Amnioreductions were undertaken twice as severe polyhydramnions developed, but on both occasions not more than 250 cc was taken out due to subjective pain. The next step was treatment with Indomethacin. As the acardiac twin was growing up to more than 50% in size of the normal sibling and the polyhydramnions was getting worse, an invasive treatment was decided to prevent possible heart failure of the pump twin as well as reducing the amniotic fluid. Ultrasound-guided umbilical cord occlusion of the acardiac twin was done in 27 weeks using usual laparoscopic instruments as an established fetoscopic surgical facility was absent. Unfortunately, amniotic membrane ruptured spontaneously 8 days leading to immediate oligohydramnions. Emergency cesarean section was then performed. The acardiac twin weighed 950 g, the pump twin weighed 900 g with Apgar scores 4 and 6 at 1 and 5 minutes respectively. Unfortunately the baby died 3 hours later due to multiple organ failure.

Keyword :

TRAP sequence, umbilical cord occlusion,


References :

  1. Martin JA, et al. Births: final data for 2000, (2002). Hyattsville, Md: National Center for Health Statistics. - : National Vital Statistics Reports


   


Archive Article

Cover Media Content

Volume : 16 / No. : 3 / Pub. : 2008-09
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  2. Comparison of brain derived neurotrophic factor (bdnf) serum level of newborn placenta between pregnant woman either obtained docosahexaenoic acid (dha) or not
  3. Ratio of bcl-2/bax expression and the changing of endometrial gland of rattus novergicus at a model of pcos with flutamide and mpa therapy
  4. Successful management of pregestational dm with severe complications
  5. A case of trap sequence at dr. soetomo general hospital