Twin reversed arterial perfusion sequence (TRAP sequence), also known as acardiac twinning, is a rare condition that occurs in pregnancies of identical twins that share one placenta. Twins that share a placenta are known as monochorionic twins.
TRAP sequence occurs in 1 percent of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. In TRAP sequence, one twin is developmentally normal (pump twin) while the other develops without a functioning heart (acardiac twin) and many other structures (head, limbs, etc.) that would allow this twin to develop into a normal fetus and newborn. The two are joined by a large blood vessel between their umbilical cords that passes through the placenta. The acardiac twin receives all of its blood from the pump twin. This causes the pump twin's heart to work harder than it typically would in a normal pregnancy.
TRAP sequence is a condition where blood flow to and from the acardiac twin is opposite of the way blood is normally supplied. In a normal pregnancy, low oxygen blood is pumped from the fetus to the placenta where it gets oxygen from the mother and is then sent back to the fetus through the umbilical cord.In TRAP sequence, the healthy twin pumps blood through the placenta to the acardiac twin in the opposite direction of the normal pumping system. The hardworking heart of the pump twin keeps both twins alive but puts the pump twin at risk for heart failure and death if left untreated. The larger the acardiac twin gets, the harder the pump twin works, increasing the risk of heart failure.