Twin Reversed Arterial Perfusion (TRAP) Sequence: Taylor's Story

In June, after more than three years of fertility treatments and several miscarriages, Cherie and Charles LaMartina of Cheektowaga, NY, were ecstatic to find out Cherie was pregnant again.

By August 2007, however, the news was not good after she went in for a routine ultrasound.

"They told me I that I was carrying twins, but there was no heartbeat for one of them. One was at 12 weeks, and the other had just stopped forming. The second fetus had no organs. We were devastated."

Cherie was sent to a fetal testing center at a local hospital in Buffalo, NY, for continued observation.

"I was told that the other twin could be absorbed by the body."

But as 22 weeks gestation approached, she noticed the twin's measurements were growing larger.

"The Fetal Testing Unit in Buffalo had never seen it before. Everyone was puzzled," Cherie says. "Why wasn't the nonviable twin getting smaller?"

Diagnosis: TRAP sequence

Two weeks later, further testing detected a serious problem called twin reversed arterial perfusion, or TRAP sequence. TRAP sequence occurs when there is a monochoriotic pregnancy in which the fetuses are contained within the same outer membrane of the sac that surrounds the fetus. Joined by a large blood vessel between their umbilical cords, one twin usually lacks an upper body and heart, while the other twin can be normal.

"Reversed perfusion" refers to the abnormal pumping action provided by the viable or "pump twin," as it pumps blood through the nonviable twin. As a result, the pump twin's heart works extra hard, risking heart failure and even death.

"We were referred and rushed to the Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia for further diagnosis," says Cherie. "They told us the healthy twin was pumping blood into the nonviable twin."

At that point, the couple also learned the extra amniotic fluid and the pressure on Cherie's heart was likely to put her into early labor. If they did nothing, the healthy, pump twin was likely to be born before 28 weeks and have a slim chance of survival.

The couple also was advised that there was a high possibility of chromosomal abnormality in the healthy fetus. "So we also had to worry about this," says Cherie.

Surgery to help Taylor

In Buffalo, the couple had been told it probably was too late for surgery. CHOP's fetal team, however, believed that TRAP sequence surgery was still an option — although it would increase the likelihood of early labor.

"We had to weigh the choices, but we made the decision to have the surgery within five minutes of talking to the team," says Cherie.

Three days later, Center surgeons performed a procedure to cut off the blood supply to the twin with no heartbeat, which would help the viable, pump twin stay in the uterus longer. Excess amniotic fluid also was extracted.

Monitoring until birth

Cherie was monitored for several weeks after the surgery, staying at the Ronald McDonald House in Philadelphia. She then returned home to her local physicians.

"At one point they rushed me in for a steroid shot to mature the baby's lungs in case she came early. I also had high blood pressure, but not toxemia," she recalls.

Taylor underwent lifesaving fetal surgery.

A Cesarean section was scheduled, and on Jan. 24, 2007, Taylor was born at 36 and a half weeks gestation. She weighed 5 lbs., 10 oz.

"All the N/IICU doctors were there. When they saw her, they said she was fine. Her lungs were fine and her sucking reflex was good," says Cherie.

An emotional time followed when the second twin, McKenzie, was born. She was just five inches long. "We had a ceremony and burial for her," says Cherie.

Happy outcome

Now Taylor is an active 4-month-old, grabbing everything and putting it in her mouth and trying to stand.

"She's the happiest baby I ever saw," says her proud mother. "She smiles all day long. We are so blessed."

Cherie says she wouldn't recommend any place other than The Children's Hospital of Philadelphia for a fetal-related problem.

"You will be so well taken care of," says Cherie. "They make you feel like things are going to be OK. 

Without the surgery we had a slim chance for Taylor. Children's Hospital pretty much saved her life, and I can't express my gratitude enough."


Originally posted: June 2009