April 26th, 2018

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Acardiac Fetus in a Triplet Pregnancy Treated with Ultrasound-Guided Percutaneous Laser: A Case Report
Authors:  Michael V. Muench, M.D., Jill Lewter, R.D.M.S., Karen Bassett, R.D.M.S., Richard H. Rupkalvis, M.D., and Henry L. Galan, M.D.
BACKGROUND: Acardiac twinning is a rare complication of monozygotic multifetal gestation that is thought to be the consequence of twin reversed arterial perfusion syndrome. In our case an acardiac fetus in a triplet gestation is presented with definitive treatment via ultrasound-guided percutaneous laser coagulation of feeding vessels.

CASE: A 22-year-old woman, G1 P0, presented at 20 weeks’ gestation with a spontaneous triplet pregnancy. Ultrasound examination revealed 2 fetuses with cardiac activity and measurements appropriate for gestational age and a mass with no cardiac activity in another amniotic sac. Color and spectral Doppler ultrasound revealed reverse flow in the feeding vessels of the mass. A diagnosis of acardiac fetus was made. Laser coagulation of the feeding vessels was performed at 21 weeks’ gestation. At 26 gestational weeks the patient underwent a cesarean section secondary to preterm premature rupture of membranes and preterm labor. Two healthy infants and a 91-g acardiac fetus were delivered.

CONCLUSION: Acardiac fetus is as rare as 1 in 35,000 births and usually is observed in monozygotic twins. We report a spontaneous triplet pregnancy successfully treated with ultrasound-guided laser coagulation.
Keywords:  acardiac fe-tus; multifetal gesta- tion; pregnancy, triplet; TRAP sequence; twin reversal arterial perfusion; ultrasound-guided laser
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