Objective To explore the clinical significance of prenatal ultrasound examination in diagnosing twin reversed arterial perfusion sequence (TRAP). Methods This was a retrospective study on 5 cases of TRAP sequence conifrmed by prenatal ultrasound and clinical method. The clinical data and ultrasound images were analyzed. Cases were collected at Hubei Maternal and Child Health Hospital from 2001 January to 2013 February. Results Four-iffths of TRAP were not corrected diagnosed and another one was misdiagnosised as asymmetrical conjoined twins in early pregnancy. Five cases of TRAP were correctly diagnosed during the second trimester. Sonographic ifndings of ifve acardia without blood lfow were as follows:(1) All acardias had no blood perfusion in body and umbilical cord, were absence of the fetal head (acephalous) and heart (acaidia), without skin edema, and a linear object resemble as umbilical cord extend from umbilical region of acardia to plcenta could be seen. Four (case 2-5) had lower limbs or dysplasia of lower limbs (two had spine), and one (case 1) had an irregular mass with bone. (2) Four pump twins had no obvious abnormity, while one had two clubfeet (case 2). Three died in uterus, one underwent induced labor due to oligohydramnios and heart dysfunction, and another one survived. Prenatal ultrasound images were consistent with MRI, X-ray examination, autopsy and postnatal neonatal examination results. Conclusions Acardia without blood lfow which was generally misdiagnosed as single gestation in utero can be diagnosed according to the special disformity of acardia and the linear umbilical cord extend from umbilical region to placenta, besides, it still need to strengthen monitoring the pump twin even if there was no blood perfusion to acardia.%目的：探讨产前超声在双胎反向动脉灌注序列征（TRAP）胎儿诊断中的临床意义。方法对2001年1月至2013年2月在湖北省妇幼保健院产前超声检查和临床确诊的5例TRAP胎儿的临床及超声检查资料进行总结分析。结果5例双胎及多胎妊娠早孕期及中孕早期首诊超声检查均未检出无心畸胎，误诊为非对称性联体双胎1例。中孕期超声检查诊断胎儿TRAP综合征5例。5例TRAP胎儿产前超声表现：（1）无心畸胎儿均无头、无心、无上肢，体内及脐血管内无血流，无全身皮肤水肿，可见一线状脐带样结构从无心畸胎儿脐部连至胎盘。其中4例（例2~4）有下肢或发育不良下肢（2例有脊柱）；1例（例1）为含骨性结构的软组织团块。（2）5例TRAP胎儿中4例泵血儿无明显异常，1例双下肢足内翻（例2）；因宫内死胎引产3例；晚孕期羊水少及心功能不全引产1例，存活1例。5例产前超声检查与胎儿MRI（2例）、引产胎儿X线检查、尸检及产后新生儿检查结果均符合。结论 TRAP胎儿中无心畸胎儿畸形严重，结构少，体内无血流时产前超声易漏诊；血流自然阻断后细线状脐带样结构是无心畸胎儿特有的畸形特征和诊断依据，发现无心畸胎儿胎体内无血流应对泵血儿加强监测。
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