{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:28:27Z","timestamp":1793726907026,"version":"4.6.1"},"reference-count":73,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T00:00:00Z","timestamp":1696032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the \u201cacardiac\u201d) lacking autonomous placental blood supply and being perfused by the co-twin (the \u201cpump\u201d), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50\u201355% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence.<\/jats:p>","DOI":"10.3390\/diagnostics13193109","type":"journal-article","created":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T04:17:19Z","timestamp":1696220239000},"page":"3109","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["\u201cThe Strange Case of Dr Pump and Mr Acardiac\u201d: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies\u2014Diagnosis, Prognosis and Management: Review of Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9652-8754","authenticated-orcid":false,"given":"Pierpaolo","family":"Nicol\u00ec","sequence":"first","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-8068","authenticated-orcid":false,"given":"Gianluca Raffaello","family":"Damiani","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Gaetani","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3522-4648","authenticated-orcid":false,"given":"Miriam","family":"Dellino","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2824-5435","authenticated-orcid":false,"given":"Amerigo","family":"Vitagliano","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Malvasi","sequence":"additional","affiliation":[{"name":"Private Practice Gynecologist, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0325-4316","authenticated-orcid":false,"given":"Gerardo","family":"Cazzato","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1287-4285","authenticated-orcid":false,"given":"Eliano","family":"Cascardi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"},{"name":"Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Marzullo","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaello","family":"Alfonso","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2390-4582","authenticated-orcid":false,"given":"Ettore","family":"Cicinelli","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9862-1619","authenticated-orcid":false,"given":"Antonella","family":"Vimercati","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area, University of Bari \u201cAldo Moro\u201d, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1309\/LM4B4DU7UIMKLNAI","article-title":"Case Report of Autopsy and Placental Examination After Radiofrequency Ablation of an Acardiac Twin","volume":"46","author":"Kashireddy","year":"2015","journal-title":"Lab. 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