Late Presentation of Acardiac Twin: A Case Report and Review of Literature

Acardiac twinning or TRAP-sequence is a rare complication of monochorionic twin pregnancy. We present a case in which fetal demise of one fetus of a twin pregnancy had been wrongly diagnosed in the first trimester as a vanishing twin. This resulted in the unexpected occurrence of an acardiac twin in the third trimester, culminating in an acardiac twin with a birth weight higher than that of the normal twin. A review is presented on therapeutic opportunities including ligation of the umbilical cord under ultrasound or fetoscopy. This case report highlights the need for correct and early ultrasonographic diagnosis of chorionicity and detailed ultrasonographic follow-up of twin pregnancies.

Twin reversed arterial perfusion sequence-a rare and dangerous complication form of monochorionic twins:A case report

BACKGROUND Twin reversed arterial perfusion(TRAP) sequence is an extremely rare congenital anomaly in monochorionic(MC) twins.The condition is characterized by a malformed fetus(acardiac twin) without cardiac activities being perfused by a structurally normal one(pump twin) via an artery-to-artery anastomosis in a reverse direction.CASE SUMMARY We described the first case of TRAP to receive laser surgery in Vietnam.The 26-wk pregnancy was originally misdiagnosed in another hospital as MC twins with single intrauterine fetal death.Following admission to our center,the diagnosis was amended to a 26-wk TRAP sequence stage IIb.The acardiac twin was 7.5 cm at the longest length,the ratio of the weight of the acardiac twin to the weight of the pump twin was more than 90%,the pump twin showed fetal distress with absent diastolic flow in umbilical artery of pump twin,and the peak systolic velocity in the middle cerebral artery = 1.6 Mo M.We performed emergency laser photocoagulation of the acardiac twin’s umbilical cord.After surgery,we successfully maintained the pregnancy for 8 wk and ended it electively by cesarean section at 34 wk of gestation due to rupture of membranes.CONCLUSION TRAP should be appropriately diagnosed and treated early to avoid complications of the pump twin.Fetoscopic laser photocoagulation is a new and effective treatment for this condition.

Twin Reverse Arterial Perfusion (TRAP): Case Report

The twin reversed arterial perfusion (TRAP) sequence is an anomaly unique to monochorionic multiple pregnancies. It is a rare complication. We present a case of acardius anephus, which was mistaken for a live anomalous singleton fetus. A 21-year-old unbooked Primigravida was seen in labour ward with a ten hours history of labour pains. Urgent transabdominal ultrasound revealed a singleton live fetus at 30 weeks gestation with gross cystic mass lesion at the level of the abdomen and polyhydramnious.?Caesarean section confirms a twin gestation with monoamniotic monochorionic single placenta. The umbilical cord of the acardiac twin was short—First twin was a live female baby, weighing 1000 g. TRAP is a rare event an early referral to feto maternal unit will improve perinatal outcome.

无心畸胎序列征实时三维超声的诊断价值及预后

目的:探讨无心畸胎序列征实时三维超声的诊断价值及其预后。方法:对7例产后随访证实的无心畸胎序列征的实时三维超声诊断结果、尸检与产后随访及其预后进行专项回顾性分析。结果:无心畸胎序列征实时三维超声图像有其特证表现,7例经尸检及产后证实为无心畸胎序列征病例与产前系统超声检查结果一致性较高,其大多预后不良。结论:实时三维超声有助于诊断无心畸胎序列征,有重要临床指导意义。

超声造影在双胎反向动脉灌注序列征伴心脏遗迹的诊断探讨

目的探讨双胎反向动脉灌注序列征伴心脏遗迹的超声造影诊断价值。方法对2例无心畸胎行常规超声检查后,采用造影剂SonoVue行超声造影,造影剂注射方法为静脉缓慢推注,选用微血管成像技术进行实时超声造影,观察造影剂在双胎及脐血管、胎盘中的灌注情况。结果2例无心畸胎胸腔内均可见心脏遗迹搏动,越近遗迹心脏心率越缓慢,越近泵血儿心率越快。超声造影灌注顺序为:泵血儿脐静脉→泵血儿体内→泵血儿脐动脉→胎盘(动脉与动脉吻合)→无心畸胎单一脐动脉→无心畸胎体内→无心畸胎脐静脉→胎盘(静脉与静脉吻合)→泵血儿脐静脉。病理解剖结果:遗迹心脏结构原始,类似原始心管结构。结论遗迹心脏无正常功能,循环仍依赖于泵血儿心脏。超声造影使我们实时观察到无心畸胎、脐血管及胎盘内的血液灌注顺序,为进一步了解无心畸胎循环特点提供重要信息。

Twin Reversed Arterial Perfusion Sequence:Prenatal Diagnosis and Treatment

Twin reversed arterial perfusion sequence,a severe and unique complication of monochorionic multiple pregnancy,is characterized by vascular anastomosis and abnormal or absent cardiac development in the twins.This article reviewed its pathogenesis,prenatal ultrasound diagnosis,and management.The pump twin’s chances for survival can be maximized by proper management.The optimal timing of the interventions remains a debate,although the latest studies encourage early intervention,i.e.,in the first trimester.The most preferred approach is to interrupt the vascular supply to the acardius,such as through ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels.

单绒毛膜双胎一胎无心畸形围产结局分析

目的探讨单绒毛膜双胎并发一胎无心畸形的围产结局及围产期管理。方法选择2010年5月至2014年5月在我院产科诊断、分娩的单绒毛膜双胎并发一胎无心畸形病例,回顾性分析在诊断无心畸形后期待治疗、选择性终止无心畸形胎儿妊娠方式的围产结局及管理。结果共13例单绒毛膜双胎并发一胎无心畸形,单绒毛膜单羊膜囊（MCMA）4例,单绒毛膜双羊膜囊（MCDA）7例,三胎妊娠合并无心畸形2例〔为单绒毛膜三羊膜囊（MCTA）、MCDA三胎妊娠〕。1例MCDA三胎妊娠孕21＋3周因难免流产转入本院,产后尸检发现无心畸形,12例于孕11＋5～31＋6周产前诊断无心畸形。9例行期待治疗,其中2例MCMA双胎发生泵血胎死亡行引产,7例分娩孕周为31＋3～39＋5周,泵血胎生长发育良好。2例在孕24周、24＋2周行脐带双极电凝术成功阻断无心胎脐带血流,于孕33＋5周、32＋1周剖宫产分娩,泵血胎生长发育良好。1例因未足月胎膜早破（PPROM）于孕28＋6周转入本院后诊断出无心畸形,因宫内感染及时终止妊娠。结论早期诊断、密切监护单绒毛膜双胎并发一胎无心畸形十分重要,必要时需要进行选择性终止无心胎妊娠以改善泵血胎妊娠结局,脐带双极电凝术为有效的宫内干预手段。

双胎反向动脉灌注序列征半心畸形的超声影像学研究

目的探讨双胎反向动脉灌注序列征（TRAP）半心畸形的超声影像学特征。方法回顾性分析9例TRAP半心畸形的临床资料，观察双胎及其附属物的超声特点，并与产后病理结果对照。结果9例TRAP产前超声声像图表现：9例半心畸胎儿胸腔内均可见遗迹心脏搏动，并探测到上下方向的动脉频谱；发育较好（多腔型）的遗迹心脏处心率较慢，发育较差（即管道型及单腔型）的遗迹心脏心率较快；9例半心畸胎儿均有全身皮肤水肿，淋巴水囊肿，发育不良的头、脊柱、腹部器官（双‘肾、肠管等），7例有膈肌；8例有双下肢，1例有单下肢；7例有上肢。9例泵血儿中7例心功能不全，5例羊水过多。9例TRAP半心畸胎儿中1例中孕期宫内血流自然阻断，泵血儿存活；8例泵血儿死亡（2例宫内死胎，5例心功能不全引产，1例羊水过多早产后夭折）。结论TRAP半心畸形自然病程泵血儿预后差，宫内易发生心功能不全。超声能准确诊断TRAP半心畸形，可用于指导临床医生早期进行宫内治疗，从而有效提高泵血儿生存率。

双胎之一无心畸形的超声诊断价值

目的探讨产前超声诊断双胎之一无心畸形的价值。方法对2007年至2012年来我院进行产前超声检查的孕妇,行胎儿系统产前超声检查,多胎妊娠尽量确定绒毛膜性,必要时行三维超声检查。将产前超声诊断结果与引产后胎儿尸检结果进行对比分析。结果经产前超声检查发现7例双胎之一无心畸形,6例经引产后尸检证实,1例经产后证实与产前超声诊断结果均相符。1例引产后行染色体检查,未发现核型异常。结论产前超声检查是诊断双胎之一无心畸形有效可行的检测手段。