Is it correct to trust each ultrasonography report blindly? a case report on misdiagnosis, diagnosis and management of acardiac twin pregnancy

Multifetal gestation is often a high-risk pregnancy and especially the monochorionic twin pregnancy significantly contributes to fetal morbidity and mortality. Acardiac twinning, earlier known as chorioangiopagus parasiticus, is the most extreme manifestation of this condition. An acardiac twin is a rare complication of multifetal pregnancy, in the literature reported at an incidence of 1% of monochorionic twin pregnancies, i.e. 1 of 35,000 pregnancies. Often results from abnormal placental vascular anastomoses. This leads to twin reversal arterial perfusion with complex pathophysiology. Here authors present a case of acardiac twin pregnancy presented at 26 weeks with the ultrasonography report suggested?? Placental teratoma of size 11×11×13 cm with polyhydramnios as there was no reason to suspect something else as the picture described in the USG report with the polyhydramnios was fitting with the diagnosis of placental teratoma but as the scan was done at taluka place and the images provided were not clear authors decided to confirm the diagnosis from fetal medicine specialist as MTP was not the option for the patient as she was 28 weeks who confirmed that as a case of acardiac twin pregnancy and the case was managed accordingly.

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Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

Medical Ultrasonography ◽

10.11152/mu-1486 ◽

2018 ◽

Vol 20 (3) ◽

pp. 396

Author(s):

Andrei Mihai Malutan ◽

Marina Dudea ◽

Camelia Albu ◽

Razvan Ciortea ◽

Doru Diculescu ◽

...

Keyword(s):

Twin Pregnancy ◽

Female Fetus ◽

Monochorionic Twin ◽

Arterial Perfusion ◽

Acardiac Twin ◽

Trap Sequence ◽

First Case ◽

Retroplacental Hematoma ◽

Twin Pregnancies ◽

Twin Reversed Arterial Perfusion

Twin reversed arterial perfusion (TRAP) sequence is a rare and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). We report on the case of a33-year-old female with a biamniotic monochorionic twin pregnancy complicated with TRAP sequence and polyhydramnios. The patient underwent fetoscopic termination of the acardiac twin and at 34 gestational weeks (GW) was readmitted with aretroplacental hematoma. The patient gave birth through caesarean section to a living female fetus, weighing 1480 g. To the best of our knowledge, this is the first case reporting a twin pregnancy with TRAP sequence complicated with retroplacental hematoma.

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Acardiac Twin

Delta Medical College Journal ◽

10.3329/dmcj.v2i2.20529 ◽

2014 ◽

Vol 2 (2) ◽

pp. 77-80 ◽

Cited By ~ 1

Author(s):

MS Maherunnessa ◽

Rahima Begum ◽

Samsad Jahan ◽

Shamsunnahar Bela ◽

Syeda Riffat Binta Habib ◽

...

Keyword(s):

Twin Pregnancy ◽

Umbilical Artery ◽

Rare Complication ◽

Multiple Pregnancy ◽

The Body ◽

Reverse Direction ◽

Arterial Perfusion ◽

Blood Flows ◽

Acardiac Twin ◽

Pump Twin

Acardiac anomaly is a rare complication of multiple pregnancies. It is a hemodyamically disadvantaged nonviable twin which occurs in association with a twin reversed arterial perfusion sequence (TRAP). In TRAP, blood flows from an umbilical artery of the pump twin in reverse direction into umbilical artery of the perfused (or acardiac) twin via an arterial to arterial (AA) anastomosis. Its blood is poorly oxygenated and results in variable degrees of deficient development of the head, heart, and upper limb structures. The lower half of the body is usually better developed, which may be explained by the mechanism of perfusion. The pump twin is at risk of heart failure and problems related to preterm birth with a reported mortality of 50-75%. We present a case of multiple pregnancy with acardiac twin in a 26 year old lady with gestational diabetes mellitus. During ante natal check up several ultrasonographic (USG) screening showed twin pregnancy with one healthy fetus and the other fetus with inconspicuous anatomy and structure. Repeat USG at 36th week of gestation diagnosed twin pregnancy with acardiac twin. Strikingly the pump twin did not develop the usual complications and was delivered by cesarean section at 37th week of gestation. DOI: http://dx.doi.org/10.3329/dmcj.v2i2.20529 Delta Med Col J. Jul 2014; 2(2): 77-80

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A Case of Trap Sequence with Immense Acardiac Twin

Folia Medica ◽

10.2478/folmed-2014-0019 ◽

2014 ◽

Vol 56 (2) ◽

pp. 129-132

Author(s):

Georgi I. Amaliev ◽

Maria L. Malinova ◽

Blagovest K. Pehlivanov ◽

Hristina A. Ivancheva

Keyword(s):

Twin Pregnancy ◽

Rare Complication ◽

Arterial Perfusion ◽

Acardiac Twin ◽

Trap Sequence ◽

Complicated Pregnancy ◽

Twin Reversed Arterial Perfusion ◽

Normal Twin ◽

Pump Twin

Abstract Twin-reversed arterial perfusion sequence is a rare complication of monochorionic twin pregnancy in which an anomalous acardiac fetus is hemodynamically dependent on its structurally normal “pump” twin. Early diagnosis is essential for improving perinatal prognosis for the normal twin. In this case report we present a case of TRAP sequence with immense acardiac twin with favorable outcome, emphasizing the importance of ultrasound imaging, follow-up and timing of delivery in this complicated pregnancy.

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Acardiac-acephalus Twinning- A Very Rare Case Report

Medicine Today ◽

10.3329/medtoday.v32i2.48839 ◽

2020 ◽

Vol 32 (2) ◽

pp. 143-144

Author(s):

Parvez Ahmed ◽

Nasrin Begum ◽

Mostofa Shamim Ahsan ◽

Mosharruf Hossain ◽

Munshi Md Arif Hosen ◽

...

Keyword(s):

Case Report ◽

Rare Case ◽

Severe Form ◽

Monochorionic Twin ◽

Arterial Perfusion ◽

Trap Sequence ◽

Rare Case Report ◽

Medicine Today ◽

Twin Pregnancies ◽

Twin Reversed Arterial Perfusion

Introduction:This study highlights a very rare case which was related to abnormal monochorionic twinning status. Case Report: This case (a 28 year old pregnant woman) came at this institute for ultrasonographic evaluation of herpregnancy status. Her ultrasonographic results were consistent with acardiac-acephalus twinning condition (which isalso known as, twin reversed arterial perfusion or TRAP sequence). Discussion: This monochorionic twin pregnancy isa severe form of twin-to-twin transfusion syndrome (TTTS) and severe TTTS has mortality rate of about 60–100%. Conclusion: This case is very rare showing prevalence of about 1/35,000 overall pregnancies and accounting 1.0% ofthe monochorionic twin pregnancies. Medicine Today 2020 Vol.32(2): 143-144

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Twin Reversed Arterial Perfusion (TRAP) Syndrome or acardiac twin: a case report in Madagascar

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20181455 ◽

2018 ◽

Vol 6 (5) ◽

pp. 1790

Author(s):

Lyn Z. A. Rabetsimamanga ◽

Hary F. Rabarikoto ◽

Maheriandrianina F. V. Rajaonarivony ◽

Setriny M. Ravoavy ◽

Hery R. Andrianampanalinarivo

Keyword(s):

Twin Pregnancy ◽

Rare Complication ◽

Cardiac Activity ◽

Upper Body ◽

Premature Delivery ◽

Arterial Perfusion ◽

Acardiac Twin ◽

Gestational Week ◽

Short Time ◽

Twin Reversed Arterial Perfusion

TRAP syndrome is a rare complication of monochorionic twin pregnancy. It is characterized by the association of an acardiac twin with a healthy twin. The acardiac twin is a parasite who put the healthy twin at high risk of cardiac failure. We report a case in a 25-year-old Malagasy woman, primigravida, who had a consultation at gestational week 31 for significant dyspnea and a threat of premature delivery. Ultrasound scans discovered an acute polyhydramnios, fetus with anasarca and low cardiac activity, and a para-fetal mass. She gives birth to a male newborn and an acardiac twin without head an upper body. The first twin died short time after birth.

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Acardiac Twin: A Rare Case Report

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1138 ◽

2016 ◽

Vol 7 (3) ◽

pp. 103-104 ◽

Cited By ~ 1

Author(s):

Nimisha N Srivastava ◽

Tulsi Bhatia ◽

Jayshree Narshetty

Keyword(s):

Case Report ◽

Preterm Labor ◽

Rare Case ◽

Monochorionic Twin ◽

Arterial Perfusion ◽

Acardiac Twin ◽

Rare Case Report ◽

Diagnostic Modalities ◽

Twin Reversed Arterial Perfusion ◽

Normal Twin

Abstract The incidence of multifetal pregnancies has dramatically increased due to assisted reproductive technology. As a result, preterm labor, Preterm premature rupture of the membranes, congenital anomalies and fetal losses are commonly encountered by obstetricians. Despite advances in diagnostic modalities and prenatal care, many times the complications associated with multifetal pregnancies may remain undiagnosed. Complications are more with monochorionic twin gestation due to placental sharing. “Twin – reversed arterial perfusion” sequence or “acardiac twin” is one such complication. This case report presents an antenatally undiagnosed monochorionic twin pregnancy, resulting in preterm delivery of a healthy, normal twin along with an acardiac acephalus co-twin. How to cite this article Srivastava NN, Bhatia T, Narshetty J, Kumar S. Acardiac Twin: A Rare Case Report. Int J Infertil Fetal Med 2016;7(3):103-104.

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Acardia anceps- A case report

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.083 ◽

2021 ◽

Vol 8 (3) ◽

pp. 408-410

Author(s):

Shital Lad ◽

Mangala Shinde

Keyword(s):

Case Report ◽

Twin Pregnancy ◽

Clinical Case ◽

Preterm Labour ◽

Large Artery ◽

Arterial Perfusion ◽

Acardiac Twin ◽

Trap Sequence ◽

Twin Reversed Arterial Perfusion

Twin-Reversed Arterial Perfusion(TRAP) sequence or Acardia twin refers to a unique complication of mono-chorionic twin pregnancy in which a twin with an absent or rudimentary non functioning heart (acardiac twin) is perfused by its co-twin (pumping twin) through a large artery to artery placental shunt, often accompanied by a vein to vein shunt. Here we discussed about a clinical case of TRAP sequence came in established preterm labour and its management.

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Acardiac – Acephalus Twin – A Rare Case Report and Review of Literature

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0039-1678625 ◽

2015 ◽

Vol 01 (01) ◽

pp. 008-011

Author(s):

Mukta Mital ◽

Tanuj Garg ◽

Prashant Gupta ◽

Vinit Nanda

Keyword(s):

Case Report ◽

Rare Case ◽

Twin Pregnancy ◽

Rare Complication ◽

The Body ◽

Review Of Literature ◽

Acardiac Twin ◽

Severe Reduction ◽

Rare Case Report ◽

Pump Twin

AbstractAcardiac twin pregnancy is a rare complication of monochorionic twinning caused by aterioarterial and venovenous placental anastomosis, leading to circulatory predominance of one twin (1). The donor “pump’ twin provides circulation for itself as well as and for the recipient acardiac twin. The acardiac twin is usually grossly abnormal with severe reduction anamolies of the upper part of the body. We present a case of acephalus acardiac anomaly diagnosed by ultrasound, with subsequent post delivery followup.

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