Abstract
Acardiac twin formation is a rare anomaly. It is one of the most extreme complications of monozygotic twin pregnancies. Such occurrences are brought about when a normal twin donates blood to an abnormal twin through its umbilical arteries via vascular anastomoses at the level of the placenta, which is termed as twin reversed arterial perfusion sequence (TRAPS). Twin reversed arterial perfusion sequence is considered a rare variant of twin-to-twin transfusion syndrome. Due to the considerable blood transfer from the healthy twin to the parasitic one, cardiac failure can ensue in the healthy twin. The mortality of the acardiac twin is 100%. We present an obstetric case of a South Asian female, whose serial ultrasound scans consistently displayed a heterogeneous mass, initially labeled a teratoma. This was postoperatively diagnosed as an acardiac twin due to TRAPS. Thus, we would like to highlight the importance of umbilical artery Doppler in the prompt diagnosis of TRAPS so timely management may be undertaken to prevent morbidity and/or mortality of the normal twin.
Highlights
Acardiac twin formation is a rare anomaly occurring in 1% of monochorionic pregnancies [1]
It is one of the extreme complications of monochorionic monozygotic twin pregnancies; it has the potential of being present in all pregnancies of higher multiples. This occurs due to a normal twin donating blood to an abnormal one, which either lacks a fetal heart or possesses a severely malformed one. This transfer of blood occurs through umbilical vascular anastomosis between the normal and acardiac twins, leading to a reversal of perfusion in the acardiac twin, and is termed twin reversed arterial perfusion sequence (TRAPS)
The anomalous twin appears as a heterogeneous mass, simulating a teratoma or even intrauterine fetal demise [3]
Summary
Acardiac twin formation is a rare anomaly occurring in 1% of monochorionic pregnancies [1]. It is one of the extreme complications of monochorionic monozygotic twin pregnancies; it has the potential of being present in all pregnancies of higher multiples This occurs due to a normal twin donating blood to an abnormal one, which either lacks a fetal heart or possesses a severely malformed one. A 34-year-old primigravida was referred to our tertiary care hospital with a suspicion of either a chorioangioma of the placenta or a placental teratoma on the second-trimester anomaly scan. The post-mortem X-ray ( Figure 3) of the malformed twin showed the incomplete formation of the lower limbs and sacrum with some calcifications present in the cephalic region. This lead to the diagnosis of an acardiac anencephalic twin
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