Soonchunhyang Med Sci.  2016 Jun;22(1):42-45. 10.0000/sms.2016.22.1.42.

Acardiac Twin-Twin Reversed Arterial Perfusion Sequence

• Kim SG
• Seo HG
• Kim YS

• KMID: 2328779
• DOI: http://doi.org/10.0000/sms.2016.22.1.42

Abstract

In general, twin pregnancy represents a high-risk pregnancy. The monozygous twin of all twin pregnancy is a real challenge for the obstetrician due to the severe complications that may arise during its development. An extremely uncommon, severe complication of monozygous twin pregnancy, which we recently experienced in Soonchunhyang University Cheonan Hospital, was a monochorionic diamniotic twin pregnancy with acardiac twin-twin reversed arterial perfusion sequence. An acardiac twin presented no heart, underdeveloped inferior part of the body, being transfused by the other fetus (pumping twin) by umbilical vessels. We report a 33-year-old pregnant woman, with a history of in vitro fertilization-embryo transfer in the second pregnancy, who presented with generalized edema, abdominal discomfort, and high blood pressure at 33 weeks' gestation. By ultrasonography, one of the babies is normally developed but in the other baby, head, upper extremities, and cardiac activity cannot be detected. The pumping twin was cardiomegaly, polyhydramnios, absent diastolic wave on the umbilical artery, and small for gestational age. We decided to terminate the pregnancy by primary cesarean section after administration of corticosteroids. The comprehension of this case is compulsory in order to provide maximum survival opportunity to the viable baby.

Keyword

Pumping twin; Acardiac twin; Monozygous twin pregnancy; Twin reversed arterial perfusion

MeSH Terms

Adrenal Cortex Hormones
Adult
Cardiomegaly
Cesarean Section
Chungcheongnam-do
Comprehension
Edema
Female
Fetus
Gestational Age
Head
Heart
Humans
Hypertension
In Vitro Techniques
Perfusion*
Polyhydramnios
Pregnancy
Pregnancy, High-Risk
Pregnancy, Twin
Pregnant Women
Twins
Ultrasonography
Umbilical Arteries
Upper Extremity
Adrenal Cortex Hormones