The normal fetus of an acardiac twin pregnancy: Perinatal management based on echocardiographic and sonographic evaluation

Donnenfeld, Alan E.; Woestune, Johanna van de; Craparo, Frank; Smith, Catherine S.; Ludomirsky, A.; Weiner, Stuart

doi:10.1002/pd.1970110405

Cited by 34 publications

(14 citation statements)

References 19 publications

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“…Some cases of ruptured uterus have been reported [1,8,9]. In our series, the delivery was vaginal in all cases and no dystocia was observed.…”

Section: Discussionsupporting

confidence: 47%

“…In this study 2 pump twins (33%) had cardiac failure; however, the TWR of 5 ranged from 50 to 142%. The ultrasound findings when cardiac failure occurs are atrial and ventricular enlargement, reverse Doppler flow over the tricuspid valve, hypokinetic ventricular movements and pericardial effusion [9]. In this study, pericardial effusion was reported in 1 case and polyhydramnios in 1 case.…”

Section: Discussionmentioning

confidence: 77%

“…They include termination of pregnancy, serial ultrasound scans to monitor for signs of decompensation, medical management of polyhydramnios or management via serial amniocenteses, digitalization for prophylaxis or for treatment of cardiac failure, hysterotomy for removal of the anomalous twin, endoscopic clamping of the anomalous twin's cord, laser coagulation of the anastomosis and embolization of the circulation of the anomalous twin [9][10][11][12][13]. In our series, no antenatal therapy was performed.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Anatomic Features of Acardiac Twins

Chanoufi¹,

Temime²,

Masmoudi

et al. 2004

Med Princ Pract

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Objective: To report 6 cases of acardiac twins, and to investigate prognostic factors that would lead to survival of the normal twin. Subjects and Methods: During a 9-year period from 1993 to 2001, 6 cases of acardiac twins out of 109,000 deliveries at the Maternity Center, Tunis, Tunisia were studied. Detailed inspection, X-rays, ultrasound and autopsies were performed. Results: Prenatal diagnosis was made in only 1 case at 33 weeks of gestation. Rudimentary cardiac tissue was observed in 2 of the 6 perfused twins, and the cephalic pole was less developed than other parts of the body. Severe agenesis or hypoplasia of the thoracoabdominal organs was commonly observed. Many limb malformations were observed, with arms the most affected. One of the pump twins was stillborn, 3 died between days 1 and 3 from respiratory distress, and 2 developed cardiac failure after birth and were treated with diuretics and digoxin, which led to a favorable outcome in only 1. The ratio of the weight of the acardiac to pump twin (TWR) ranged from 50 to 142%. Conclusion: The findings of this study indicate that acardia can be diagnosed by means of ultrasound in front of a monochorial twin pregnancy when one of the fetuses is deformed and has no cardiac activity. Heart failure and polyhydramnios, as well as a TWR greater than 50% are prognostic factors for the pump twin.

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“…Some cases of ruptured uterus have been reported [1,8,9]. In our series, the delivery was vaginal in all cases and no dystocia was observed.…”

Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Clinical and Anatomic Features of Acardiac Twins

Chanoufi¹,

Temime²,

Masmoudi

et al. 2004

Med Princ Pract

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“…Hydrops fetalis is caused by a high output state in fetuses with large tumors (Lo¯and and Filston, 1987;Eldar-Geva et al, 1988). Maternal digoxin treatment for hydropic fetuses with Ebstein's anomaly or for the normal fetus of an acardiac twin has been reported to be effective (Donnenfeld et al, 1991;Koike et al, 1997), and it is safe and effective in treating fetal tachyarrhythmias (Kleinman et al, 1985). Thus, we tried to prevent fetal cardiac compromise by inotropic action of digoxin; however, the fetus became hydropic.…”

Section: Discussionmentioning

confidence: 99%

Prenatal MRI in a fetus with a giant neck hemangioma: a case report

et al. 2000

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“…Angiograms have been described in acardiac twin pregnancies to visualize the pattern of anastomoses [18]. In our case, this was inspired by Prof. Laurini to find out whether deep AV anastomoses were still functional.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Twin-Twin Transfusion Syndrome by Laser and Digoxin

Arabin

Laurini

Eyck³

et al. 1998

Fetal Diagn Ther

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Objectives: A combination of surgical and medical approaches may address both the underlying pathophysiological processes and the most threatening symptoms in twin-twin transfusion syndrome (TTTS). Case: A primigravida with monochorionic twin pregnancy was referred with signs of TTTS at 16 weeks. One twin was severely hydropic with normal amniotic fluid, the co-twin had anhydramnios. Laser treatment was performed. Nevertheless, signs of severe cardiac decompensation in the recipient remained unchanged. After treatment with digoxin restoration of congestive heart failure and a resolution of the hydrops were achieved. Activity and inter-twin contacts increased significantly. At 37 weeks 2 healthy boys were delivered. Postnatal computerangiography of the placenta revealed no arteriovenous anastomoses. Conclusions: This case suggests that a combined causal and symptomatic therapy in cases with cardiac decompensation of the recipient can be beneficial as demonstrated by echocardiography, venous Doppler and behavioral analysis. Computer angiography of the placenta may demonstrate the effect of laser treatment.

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The normal fetus of an acardiac twin pregnancy: Perinatal management based on echocardiographic and sonographic evaluation

Cited by 34 publications

References 19 publications

Clinical and Anatomic Features of Acardiac Twins

Clinical and Anatomic Features of Acardiac Twins

Prenatal MRI in a fetus with a giant neck hemangioma: a case report

Treatment of Twin-Twin Transfusion Syndrome by Laser and Digoxin

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