Monochorionic Triplet Pregnancy with an Acardiac Twin: A Poor Prognostic Case

Arlen Resnawaldi; Merlin Margareth Maelissa; Desmiranty Anisha Tipaheuw; Steffi Ribka Ngosiem; Joel Apriyanto Fejacreyo Huka

doi:10.24198/obgynia.v9i2.1034

Monochorionic Triplet Pregnancy with an Acardiac Twin: A Poor Prognostic Case

Arlen Resnawaldi, Merlin Margareth Maelissa, Desmiranty Anisha Tipaheuw, Steffi Ribka Ngosiem, Joel Apriyanto Fejacreyo Huka

Abstract

Introduction: Twin Reversed Arterial Perfusion (TRAP) sequence, or acardiac twin, is a rare complication in monochorionic pregnancies due to abnormal placental anastomoses, leading to reversed perfusion and increased risk of heart failure, polyhydramnions, prematurity, and high mortality until 75% if untreated.
Case report: A 29-year-old multigravida with a monozygotic triamniotic triplet pregnancy at 20–21 weeks presented with vaginal bleeding. Ultrasound revealed two non-viable fetuses and one suspected intrauterine demise. Vaginal delivery produced two stillbirth females neonatus (295 g and 275 g) and one malformed acardiac fetus (160 g). The placenta was monochorionic with two umbilical cords. Final diagnoses: complete abortion, monozygotic triamniotic triplet pregnancy, and acardiac twin (TRAP).
Conclusion: TRAP in monochorionic triplet pregnancy carries poor prognosis. Early detection and referral to tertiary centers with fetal therapy are vital to improve outcomes.

Kehamilan Triplet Monokorionik dengan Janin Akardiakus: Kasus dengan Prognosis Buruk

Abstrak
Pendahuluan: Twin Reversed Arterial Perfusion (TRAP) sequence atau janin akardiakus merupakan komplikasi langka pada kehamilan monokorionik yang terjadi akibat adanya anastomosis plasenta abnormal. Kondisi ini menyebabkan aliran perfusi terbalik sehingga meningkatkan risiko gagal jantung pada janin donor (pump twin), polihidramnion, prematuritas, serta mortalitas tinggi hingga mencapai 75% bila tidak ditatalaksana.
Laporan Kasus: Seorang wanita berusia 29 tahun, multigravida, dengan kehamilan triplet monozigot triamniotik pada usia kehamilan 20 – 21 minggu datang dengan keluhan perdarahan pervaginam. Pemeriksaan ultrasonografi menunjukkan dua janin tidak hidup dan satu janin diduga mengalami kematian intrauterin. Persalinan pervaginam menghasilkan dua neonatus perempuan lahir mati (berat 295 g dan 275 g) serta satu janin akardiakus dengan malformasi (berat 160 g). Plasenta monokorionik dengan dua tali pusat. Diagnosis akhir: abortus komplit, kehamilan triplet monozigot triamniotik, dan janin akardiakus (TRAP sequence).
Kesimpulan: TRAP pada kehamilan triplet monokorionik memiliki prognosis yang buruk. Deteksi dini dan rujukan ke pusat pelayanan tersier dengan fasilitas terapi fetal sangat diperlukan untuk memperbaiki luaran kehamilan.

Keywords

Acardius amorphous type; fetal demise; monochorionic triplet; TRAP sequence

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DOI: http://dx.doi.org/10.24198/obgynia.v9i2.1034