Challenge in the Management of Twin Pregnancy with Anencephaly of One Fetus in a Low- Income Country: A Case Presentation

Romaric Joel Momo

doi:10.11648/j.jgo.20190703.15

Abstract

Anencephaly of one twin is a frequent congenital abnormality in a twin pregnancy and it’s associated with a poor prognosis of this pregnancy. In developed countries, the goal standard management calls for an interventional fetal medicine either by injection of a cardiotoxic or by intervention on the umbilical cord. Another option is an expectative management with strict follow-up of pregnant women and delivery organized in a level 3 maternity. There is still a challenge in the management of such high risk pregnancy in low income countries. A 37 years-old female, G3P2002, referred from a clinic for the better management of a 28 weeks and 4 days twin pregnancy in labor. Obstetrical ultrasonography realized in the second trimester revealed dichorionic-diamniotic pregnancy and the presence of anencephaly with hydramnios of one twin. The expectative approach was adopted for the management of this high risk pregnancy, unfortunately the death of the fetus occurred despite all the care provided. This case brings to lamp light the difficulties encountered in providing standard obstetrical care for high risk pregnancies in resource limited settings.

Highlights

A multiple pregnancy is a medical condition usually associated with malformations
One of the risk factors is the folic acid deficiency that was presumed in our patient who didn’t take the prophylaxis
Amadaou A et al found that the clinical frequency of Anencephaly was 5.5% in all twin pregnancy [4]

Summary

Introduction

A multiple pregnancy is a medical condition usually associated with malformations. The risk is about 1.6 to 2 times comparing to a normal intra-uterine singleton pregnancy [1]. Is the most frequent malformation seen in twin pregnancies besides cardiac and renal defects; frequently encountered malformations in twin gestations [2]. It can affect the prognosis of the pregnancy and necessitate a higher technical platform and an expert in fetal medicine. The marked improvement in fetal medicine in developed countries has contributed to increase in the prognosis of such pregnancies, compared to less-developed countries where case series reveal a lower prognosis [4]. This case exposes the challenges in the management of such pregnancies in low income countries

Case Presentation

Discussion

Conclusion

Findings

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