Twin reversed arterial perfusion (TRAP) sequence is a unique complication of monochorionic twinning characterized by no heart development and related to a variety of malformations in one of the twins, which is perfused in a paradoxical retrograde fashion by the essentially normal, structurally 'pumping' twin through a single artery-to-artery anastomosis. We report a pregnancy at 15 gestational weeks and follow-up until term with TRAP sequence and spontaneous fetal demise of acardiac fetus. At 38 + 4 gestational weeks, a cesarean delivery was performed; the co-twin had a birth weight of 3240 g and the acardiac twin had an umbilical knot.
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