Acardiac fetus complicating a triplet pregnancy: management and outcome

Sepúlveda, Waldo; Wong, Amy E.; Bustos, Juan Carlos; Flores, Ximena Figueroa; Alcalde, Juan L.

doi:10.1002/pd.2291

Cited by 19 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early attempts were highly invasive and involved hysterotomy and removal of the acardiac twin [2,3,4]. Subsequently, a series of other less invasive intrauterine interventions aiming to arrest the circulation of the acardiac twin were introduced [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. These included insertion of cord coils, ligation with or without transection of the umbilical cord, endoscopic laser coagulation of placental anastomoses between the pump and acardiac twins, endoscopic laser coagulation and endoscopic or ultrasound-guided monopolar or bipolar diathermy of vessels within the cord supplying the acardiac twin and, more recently, ultrasound-guided ablation of intrafetal vessels by injection of alcohol, monopolar diathermy, laser or radiofrequency.…”

Section: Introductionmentioning

confidence: 99%

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

View full text Add to dashboard Cite

Introduction: The objective of this study was to define the optimal method and timing of intervention in twin reversed arterial perfusion (TRAP) sequence. Material and Methods: During a period of 20 years (1993-2013), we performed endoscopic laser coagulation of umbilical cord vessels or intrafetal laser in 67 pregnancies with TRAP sequence. These data were combined with those reported in the literature to determine the survival rate of the pump twin for different methods and timing of interventions. Results: A variety of techniques were used to interrupt the blood supply to the acardiac twin. Most procedures were performed at or after 16 weeks, and with most methods the survival rate of the pump twin was about 80%. Good results were also obtained for triplet pregnancies. In 18 of 30 cases (60%) diagnosed at 11-14 weeks, there was spontaneous cessation of flow in the acardiac twin before planned intervention at 16-18 weeks, and in 11 of these (61.1%) the pump twin died or suffered brain damage. In 103 pregnancies treated by intrafetal laser at 12-27 weeks, there was no correlation between gestational age at treatment and survival rate, but there was an inverse association between gestational age at treatment and gestational age at birth. Discussion: In TRAP sequence, survival may be improved by elective intervention at 12-14 weeks.

show abstract

Section: Introductionmentioning

confidence: 99%

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In the first case,1 the diagnosis was a congenital cystic adenomatoid malformation of the lung. In the second case,3 one of the triplets was found to be acardiac. In the third case report,4 one of the triplets had hydropic acardia resulting in mirror syndrome.…”

Section: Discussionmentioning

confidence: 83%

Spontaneous monochorionic triplet pregnancy with no fetal anomaly or feto-fetal transfusion

Gandham

Ogueh

2012

BMJ Case Reports

View full text Add to dashboard Cite

We present a case of spontaneously conceived monochorionic triamniotic triplet pregnancy with no fetal anomaly or feto-fetal transfusion. The mother developed gestational diabetes at 20 weeks gestation, and at 20 weeks and 4 days gestation triplet 2 was found to have selective growth restriction and absent end diastolic flow. Although laser treatment and clamping of the umbilical cord of the growth-restricted baby was considered, the management was conservative with regular ultrasound scans and antenatal corticosteroids at 24 weeks gestation, and the umbilical artery Doppler reverted to normal at 26 weeks and 4 days and growth velocity was maintained. An elective caesarean section was performed at 33 weeks gestation to deliver three boys in excellent condition who only required feeding support.

show abstract

“…The classically reported incidence of TRAP sequence is 1/35,000 pregnancies [1,2,4,6,[10][11][12][13][14] and most of these cases occur in monozygotic twin gestations. Acardius in triplet gestations constitutes only 8% of all acardiac cases and there have been fewer than 20 such cases described in the literature thus far [8] .…”

Section: Discussionmentioning

confidence: 99%

“…This clinical entity involves artery-to-artery anastomoses resulting in a structurally normal "pump" twin that provides circulation to an acardiac twin recipient in a retrograde fashion [1][2][3][4] . There are two theories regarding the etiology of TRAP sequence.…”

Section: Introductionmentioning

confidence: 99%

A case of twin reversed arterial perfusion (TRAP) sequence in a monochorionic diamniotic triplet pregnancy with two acardiac fetuses

May

Lanni

Jakowski

2016

IJDI

View full text Add to dashboard Cite

Background: Twin reversed arterial perfusion (TRAP) sequence is a rare anomaly of monochorionic twins involving artery-to-artery anastomoses resulting in a structurally normal "pump" twin that provides circulation to an acardiac twin in a retrograde fashion.Case: Herein we report a rare case of a triplet gestation (TrGA) consisting of two conjoined acardiac TRAP recipients and one surviving normal pump fetus. The TRAP recipients were discordant for their anomalies. We know of only three similar case reports from the literature. Conclusion:Characteristic ultrasound findings allow for the prenatal diagnosis of TRAP sequence and may allow prompt and appropriate treatment to improve the outcome of the pump twin.

show abstract

Acardiac fetus complicating a triplet pregnancy: management and outcome

Abstract: The presence of an acardiac fetus in a triplet pregnancy carries a high risk for poor pregnancy outcome, including fetal death and severe preterm labor. Prenatal intervention may be indicated in some cases, but does not prevent fetal death of the pump twin.

Cited by 19 publications

References 21 publications

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Spontaneous monochorionic triplet pregnancy with no fetal anomaly or feto-fetal transfusion

A case of twin reversed arterial perfusion (TRAP) sequence in a monochorionic diamniotic triplet pregnancy with two acardiac fetuses

Contact Info

Product

Resources

About