P23.13: Laser coagulation in triplet pregnancy with acardiac fetus: a case report

Abstract

Case: We report a series of 12 consecutive TRAP cases referred to our institution since January 2006. Among these cases, 9 were monochorionic/diamniotic twin pregnancies, whereas three were dichorionic/triamniotic triplet pregnancies with an affected monochoric/dimaniotic twin pair. Prenatal karyotyping was performed in 5 of the 12 cases revealing 4 euploid pump twins and 1 case of mosaic 46XX/45X. Detailed prenatal sonographic and echocardiographic assessment of the pump twin was performed in all cases, and three (25%) of the pump twins were noted to have fetal skeletal malformations. In case 1, the pump twin was noted to have an abnormal calvarial contour, markedly shortened fetal long bones and small chest circumference suggestive of a lethal skeletal dysplasia. In case 2, the pump twin was noted to have a single umbilical artery, abnormal 4 th and 5 th digits of the upper extremities. In case 3, marked angulation of the lower thoracic/upper lumbar spine was noted consistent with hemivertabrae. This pump twin was noted to also have a 1 cm perirenal cyst consistent with a urinoma, but no other major structural malformations were detected among any of the pump twins. Conclusion: TRAP is a rare complication of monochorionic twinning that results not only in the growth of a non-viable acardiac twin, but also in an increased risk of chromosomal abnormalities and structural malformations among pump twins. In addition, we noted a 25% incidence of fetal skeletal malformations among pump twins. P23.13Laser coagulation in triplet pregnancy with acardiac fetus: a case report C. Flores Acosta, G. Smith Doria, A. Villarreal, A. Lopez, D. Saldívar Rodríguez Hospital Universitario Dr. Jose E. Gonzalez, Monterrey, Nuevo Leon, MexicoA 26 year old, G3 C2 was referred to the fetal medicine unit because of triplet pregnancy with hydropic fetus. The ultrasound performed revealed a triplet pregnancy fetus 1 male of 17.1 weeks anterior placenta and normal amniotic fluid. Fetus2 female of 16.1 weeks and fetus3 with development only of thorax, abdomen and lower extremities, generalized oedema and no cardiac activity, a presence of retrograde perfusion by colour Doppler ultrasound was observed. At 18.2 weeks using local anaesthesia, an ultrasound guided laser coagulation was done to the umbilical cord of the acardiac fetus introducing the laser fiber DIOMED throw an 18 G needle applying 15 W pulses. Doppler US was use to prove the absence of flow. At 28.6 weeks of gestation the patient presents premature labor, and she was admitted to the hospital for tocolisis developing abruptio placentae, leading to a caesarean section. Results: Male product 1220 gram. Apgar score 8-9, female 1060 gr, Apgar 0-3 and one amorphous 200 gr product. Conclusions: The twin reverse arterial perfusion (TRAP), is a serious complication affecting 1/35000 pregnancies. The primary malformation is the absence of a well-defined cardiac structure in one of the twins, which receives arterial blood flow through placental arterio-arterial anastomosis from the other t...