Reverse Arterial Perfusion syndrome (RAPS) or acardial triplets: A clinical case

Abstract

Relevance: Reverse arterial perfusion syndrome of twins (RAPS) is a rare but serious complication of monozygotic monochorionic twin pregnancies. The outcome is invariably fatal for abnormal twins and for 50-75% of normal twins. A prenatal diagnosis of RAPS should always be assumed in the case of multiple pregnancies, during which a pair of twins is growing, when cardiac activity cannot be confirmed by echography.
The study aimed to present a clinical case of bichorial triamniotic triplet pregnancy with an acardius as an example of determining a possible way to reduce perinatal mortality.
Materials and Methods: The study describes a rare clinical case of reverse arterial perfusion syndrome of twins who were treated at the Regional Perinatal Center No. 1 (Turkestan region, Kazakhstan) in 2024.
Results: This article presents a rare clinical case of reverse arterial perfusion syndrome of twins in a patient with a preliminary diagnosis. The gestational age was 29 weeks 2 days, I period of labor. The triplets were dichorial and triamniotic. Intrauterine death of the second fetus (a volumetric teratoma formation). Varicose veins of the lower extremities. Moderate anemia. This case was the first at the Regional Perinatal Center No. 1 of the Turkestan region. A pregnant woman repeatedly underwent ultrasound during pregnancy, which established undeveloped pregnancy of the third fetus with congenital malformation of the fetus anencephaly at 12 weeks. After a consultation with physicians, taking into account the current obstetric situation (1 period of labor, triplets) the patient was administered emergency Cesarean section in the lower uterine segment in the interest of the fetuses. The patient was discharged after 10 days with recommendations.
Conclusion: The presented clinical case shows that an obstetrician-gynecologist and radiologist should be aware of this anomaly, especially in double/multiple pregnancies, so that appropriate measures can be taken in a timely manner for the survival of a twin with a pump. The pathologist should also be aware of this entity to provide parents with a proper autopsy report so that they can plan their future pregnancy. It also highlights the importance of opening the fetus.