TRAP sequence

Twin reversed arterial perfusion sequence—also called TRAP sequence, TRAPS, or acardiac twinning—is a rare complication of monochorionic twin pregnancies.

It is a severe variant of twin-to-twin transfusion syndrome (TTTS).

The twins’ blood systems are connected instead of independent.

One twin, called the acardiac twin or TRAP fetus, is severely malformed.

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The heart is missing or deformed, hence the name acardiac, as are the upper structures of the body.

The legs may be partially present or missing, and internal structures of the torso are often poorly formed.

The other twin is usually normal in appearance.

The normal twin, called the pump twin, drives blood through both fetuses.

It is called reversed arterial perfusion because in the acardiac twin the blood flows in a reversed direction.