Bipolar cord coagulation for selective feticide in a monochorionic twin pregnancy complicated by pentalogy of Cantrell

Abstract

We present a 32-year-old primigravida with no history of hereditary diseases or malformations in the family. The patient did not have any diseases. Her surgical history included an hysteroscopic myomectomy and a appendecectomy. The patient came to our center to have her pregnancy controlled in the high-risk obstetric area where she was diagnosed as having a monochorionic diamniotic spontaneus twin pregnancy. A routine first trimester ultrasound during week 11 þ2 revealed a monochorionic diamniotic twin pregnancy. The growth of both fetuses corresponded to their gestational age. During the anatomical examination of one fetus, the following findings were observed: increased thickness of nuchal translucency (5 mm), omphalocele, and ectopia cordis (Figs. 1e3). The cardiac anatomy impressed normal, a nasal bone was observed. There was an A wave in the ductus venosus and no evidence of tricuspid regurgitation. The other fetus had a normal anatomy. The patient was informed that one fetus had a suspected case of pentalogy of Cantrell. Seven days later, she was called for a reassessment. At 7 days, the following findings were observed in the fetus' cardiac anatomy (Fig. 4): aortic override, interventricular communication, and retrograde filling of the pulmonary artery. (These findings suggested tetralogy of Fallot.) Amniocentesis was performed on both amniotic sacs for chromosomal studies. The results were normal for both fetuses (i.e., 46, XY/46, XY).