Dichorionic Triamniotic Triplet Pregnancy Complicated by Acardius Acormus

Abstract

This report describes an acardiac fetus of the acormus phenotype in a triplet pregnancy. The diagnosis was confirmed at 15 weeks. In the absence of signs of heart failure in the co-fetus the pregnancy was managed conservatively. The pregnancy was complicated by preterm labour and the fetuses were delivered at 26+5 weeks. The prenatal diagnosis of the acormus phenotype with a well-developed cephalic pole is extremely rare and has never been described antenatally in a higher order multiple pregnancy. We suggest that this rare acardiac fetus phenotype may have a different pathophysiology than those of other phenotypes. The report also summarizes the perinatal outcomes of triplet pregnancies complicated by an acardiac fetus, where the median gestational age at delivery is 26–27 weeks, and discusses the possible therapeutic interventions.

Acardia: Epidemiologic findings and literature review from the International Clearinghouse for Birth Defects Surveillance and Research

“…Acephalus and anceps are sometimes grouped together and appear to account for most (>70–80%) reported cases of acardia. Very rarely, the reverse situation is observed: cephalic structures are present with little or no truncal development (acormus) [Morizane et al, 2002; Abi‐Nader et al, 2009; Cruz‐Hernández et al, 2009; Obladen, 2010; Guimaraes et al, 2011; Huss et al, 2011]. Finally, all cephalic and truncal differentiation may be lacking (amorphous), to the extent that the fetal parts may be misclassified as a teratoma [Dahiya et al, 2004; Lattanzi et al, 2006; Phelan and Hall, 2006; Hanley et al, 2007; Kariappa et al, 2007].…”

Gestational echobiometry in brachycephalic bitches using high-definition ultrasonography

“…Measurement of the gastric wall was facilitated after day 27, a fact never reported in canine fetuses. This parameter has great clinical relevance in humans as it relates to prenatal genetic therapies for gastrointestinal diseases (Abi-Nader et al 2009) and can provide subsidies for future studies in small animals.…”

Spontaneous Triplet Pregnancy Complicated by Uterus Didelphys: A Case Report

“…In these cases fetal assessment is made through morphometric and hemodynamic criteria [19] . When the hemodynamic status of one of the fetuses is compromised an intervention to separate both placental circulations is needed.…”

“…Placental individualization may be performed directly on the placenta through laser ablation of anastomosis or via interrupting the blood flow through the umbilical cord (ultrasound-guided injection of alcohol or coils, radiofrequency and diathermy or fetoscopically guided ligation or laser ablation). The election of a concrete approach depends mainly on the gestational age [19] .…”