Acardiac Twins: Pathophysiology, Diagnosis, Outcome and Treatment

Abstract

Twin gestation is often a hazardous pregnancy and especially the monochorionic twin pregnancy significantly contributes to fetal morbidity and mortality. Among the serious complications with twins, the twin-twin transfusion syndrome complicates 5–35% of monozygotic twin pregnancies with monochorionic placentation. Acardiac twinning, earlier known as chorioangiopagus parasiticus, is the most extreme manifestation of this condition. An acardiac twin is a rare complication of multifetal pregnancy, in the literature reported at an incidence of 1% of monochorionic twin pregnancies, i.e. 1 of 35,000 pregnancies. In the following paper we review the literature on the subject and report 6 cases, 5 twins and 1 triplet, that were diagnosed at our department during the period of 1993–1997 and treated conservatively. Only 1 child survived.

Acardiac Acephalus Twin diagnosed at delivery: A case report

“…Late diagnosis with compromised twins may be an indication for termination of pregnancy in view of unfavourable outcome for unborn children and mother [7,8].…”

Acardiac Acephalus Fetus Presenting as Obstructed Labour: A Case Report

“…Acardiac acephalic twin pregnancy is one of the rarest and unique complications of monozygotic twin pregnancy [1]. Four types of acardiac fetuses have been described in the literature [3].…”

“…A 24 year old woman gravida [2], para [1], at 37 completed week's gestation came to emergency room in labour. She was referred as a case of obstructed labour.…”

“…The estimated incidence of this complication is 1 in 35,000 pregnancies [1]. It results from abnormal placental vascular anastomosis [2].…”

Intrafetal alcohol ablation of an acardiac twin

“…[2][3][4] The treatment options for acardiac twinning include expectant management, amniodrainage, and invasive treatment such as hysterotomy with selective delivery of the acardiac twin, intra-fetal ablation of the acardiac twin by alcohol, radiofrequency, laser or thermo-coagulation, ultrasoundguided funicular occlusion by ligation, intra-funicular embolization with foreign bodies, and fetoscopic umbilical cord occlusion by ligation, laser or thermocoagulation. [5][6][7][8][9][10][11][12][13][14][15] Invasive interventions have their own inherent risk and here we report successful treatment of an acardiac twin using ultrasound-guided intra-fetal ablation with alcohol in mid-trimester.…”