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Twin doppler heart doppler12/27/2023 ![]() Preterm delivery is seen in 90%, polyhydramnios in 40%, and congestive heart failure in 30% when this ratio is above 70% ( 5). One of the prognostic factors is the ratio of the weight of the acardiac twin to the weight of the donor twin (%). Significance of early diagnosis is clear both for determining the therapy and also timely terminating the pregnancy which has a high mortality ( 2). Chromosomal anomalies that are reported as 9% should be excluded for management of TRAP sequence. ![]() Mortality of pump twin is around 50% and death may usually be due to heart failure and sometimes prematurity caused by polyhydramnios ( 5). It is as an amorphous tissue mass and it consists approximately 5% of all cases. It is widely classified into four subgroups morphologically ( 4, 7).Īcardiac amorphous: the fetus has no identifiable organs. Halocardia is the absence of cardiac structure development. Pseudocardiac is the presence of cardiac structures although rudimentary. Doppler studies may show pathognomonic features of reverse flow on artery-artery anastomosis ( 1).Īcardiac fetus is clinically divided into two types. Prenatal diagnosis of acardiac fetus may be made with ultrasonography at the end of the first trimester ( 3). Atrophy is higher in the cranial parts as the caudal part uses blood predominantly ( 5).Īntenatal diagnosis may be made by absence of the heart on ultrasonography and revealing placental vascular anastomosis with Doppler despite presence of trunk and extremity movements in the twin that has multiple anomalies ( 6). The acardiac twin survives through these anastomoses, it uses blood which has poor oxygen, coming from cardiac twin flows reversely in arteries of the acardiac fetus and normal tissues of this fetus are partially atrophic. In acardiac fetus placenta blood circulation between acardiac fetus and donor fetus is provided by artery-artery and vein-vein anastomosis on the placental surface ( 2, 4). Organogenesis defect due to anastomosis in the placenta during the early embryonic period is suggested in the pathogenesis of TRAP sequence ( 1). ![]() TRAP sequence represents a variant of conjoint twins in which chorionic circulation is shared ( 3). Chorionicity, presence of hydropic, acardiac and acephalic twin and Doppler USG findings were consistent with TRAP sequence. Under the light of these data, twin-twin transfusion syndrome and TRAP sequence were considered in the radiologic differential diagnosis of this complicated monochorionic–monoamniotic twin pregnancy. On Doppler USG, umbilical artery systolic/diastolic (S/D) ratio increased in the pump twin and within normal ranges in the recipient twin ( Figure 3). Umbilical circulation occurred through reversed perfusion in the recipient twin. The fetal abdomen was surrounded with a large hydrops ring and the lengths of the extremities were consistent with 20 weeks and 2 days ( Figure 2). Biparietal diameter and head circumference measurements could not be done as the fetal cranium could not be observed. Fetal cardiac activity was not detected in the rudimentary thorax of the second fetus. Cardiac activity was rhythmic in the first fetus and fetal heart rate was 149 beat per minute and morphometric measurements were consistent with 23 weeks and 4 days, and no anomalies were detected. On obstetric ultrasonography, she had an intrauterine monochorionic monoamniotic twin pregnancy ( Figure 1). Her medical history and family history were unproblematic and she did not have any systemic diseases. A 21-year-old pregnant woman with 23 weeks of gestational age was referred to our clinic for advanced ultrasonography and Doppler examination with prediagnosis of fetal anomaly.
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