Objective To investigate the predictive value of twins’growth and development discrepancy in prenatal ultrasound diagnosis of twin reversed arterial perfusion sequence (TRAPS) in the first trimester of pregnancy at 8-11 weeks of pregnancy. Methods From May 2001 to August 2021, the prenatal ultrasound diagnosis of Hubei Province Maternal and Child Health Hospital and the diagnosis confirmed by post-induction or post-natal pathology were collected 153 Cases of TRAPS, 37 cases of prenatal ultrasound examinations at 8-11 weeks of gestation were retrospectively analyzed, and 42 cases of monochorionic twin pregnancies in early pregnancy with no obvious structural abnormalities in prenatal ultrasound system examination and postpartum follow-up were collected as the control group. Summarized the ultrasound characteristics and counted the difference in the number of days corresponding to the gestational week size of the two fetuses in the first trimester and the difference in embryo length separately, and the receiver operating curve (ROC) was used to evaluate the predictive value of TRAPS in the first trimester. Results 1. Among 37 cases of TRAPS, 36 cases were twin pregnancy, 1 case was triple pregnancy, 42 cases in normal group were twin pregnancy. 2. 37 cases of TRAPPS in the larger embryos were visible normal cardiac throbbing, 34 cases of smaller embryos did not see obvious cardiac throbbing, 3 cases of visible cardiac throbbing, 42 cases of control group double fetuses were visible normal heart tube throbbing.3 .There was no significant difference in the age of the two groups of patients and the clinical gestational weeks of the two fetuses (P>0.05); the difference in ultrasound gestational weeks between the two fetuses in the study group and the control group was 9.1±6.9 days and 1.6±1.5 days, respectively. The results of the two groups were statistically different (P<0.05); the difference in embryo length between the study group and the control group was 10.3±7.7mm and 1.9±1.9mm, respectively, and the results of the two groups were statistically different (P<0.05). 4. Using the receiver operating curve (ROC) analysis, when the difference between two embryos is more than 5 days and the length of two embryos is more than 4.5 mm as the cut-off value for diagnosis of TRAPS, the area under the curve, sensitivity, specificity, the positive predictive value and negative predictive value were 0.65 vs 0.66, 67.6% vs 75.7%, 97.6% vs 97.5%, 92.3% vs 87.8%, and 77.3% vs 82.2%, respectively. Conclusion The uncoordinated growth and development of twin fetuses and the absence of significant cardiac throbbing in one of the embryos were of high value to predict the occurrence of TRAPS during 8-11 weeks of early pregnancy.