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Re: Acardiac twinFrom: T-H Bui, Clinical Genetics, Karolinska Hospital (bui@gen.ks.se)Thu Nov 20 08:07:27 1997
At 23.36 1997-11-18 -0600, you wrote:
>>>> <excerpt>We have a patient currently at 14 weeks, twin pregnancy with an acardiac twin (TRAPS). The mortality for the normal twin is probably about 50%. Options: 1. Observe closely, ? serial amniocentesis if polyhydramnios develops. 2. Attempt to occlude umbilical artery of acardiac twin ? methods. We have no-one here expert in fetoscopy. Has anyone injected the acardiac twin with an arterial sclerosant or percutaneously embolized its circulation? </excerpt> ad 1. serial amniodrainage can be done, although you may try septostomy first. ad 2. the TRAP-sequence is associated with at least 50% mortality of the pump twin due to high-output cardiac failure of the normal twin or as a consequence of polyhydramnios and prematurity (Moore et al. Am J Obstet gynecol 1990; 163: 907-12). Thus, amniodrainage is indicated when needed. Fetoscopic cord ligation or coagulation (before 21 wks) is unfortunately not available in your setting. Ultrasound guided cord embolisation is technically not so difficult; however, as both fetuses share the same circulation, the embolisation product may be transfer to the healthy co-twin, and therefore some centres do not perform this anymore. Get in touch with "Holzgreve,Wolfgang" <<Holzgreve@ubaclu.unibas.ch> at the University of Basel about percutanaeous embolisation. Good luck. *************************************** The-Hung Bui, MD -- Associate Head Physician
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