This rare condition (1:35,000 pregnancies) arises in MC twins with two cords linked by a large arterio-arterial anastomosis such that flow from one, the 'pump twin,' supplies the other, the 'perfused' twin, in a retrograde fashion. The term 'twin reversed arterial perfusion' (TRAP) sequence is preferred to the older 'acardiac monster', so named as reversed deoxygenated arterial supply is associated with only rudimentary development of upper body structures such as the heart, face and arms. Perinatal mortality in the pump twin is up to 55%, due to polyhydramnios and cardiac failure . Although polyhydramnios may be alleviated by amnioreduction or sulindac therapy, definitive treatment requires occlusion of the perfused twin's cord, which can now be achieved by a variety of feto-scopic or ultrasound-guided techniques. Techniques such as radiofrequency ablation and interstitial laser which occlude intrafetal rather than cord vessels give the best results, with a pump twin survival rate of > 80% .
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.