^{Portsmouth Naval Hospital in Portsmouth, VA}

Image taken at 10 weeks gestation during endovaginal sonogram. There is a poorly formed hydropic fetus (aside from 2 other normal twins).

Color Doppler demonstrating flow toward the transducer with no flow seen away from.  No cardiac structure seen.  Transverse uterus demonstrating 3 fetuses.

Transverse uterus demonstrating 3 fetuses.

The acardiac fetus was embolized in the early second trimester. A follow-up around 25-26 demonstrated that the embolized cord on the acardiac fetus had re-anastomosed at some point. The acardiac fetus was growing to an enormous size. We continued to watch the babies as the 2 surviving ones were showing a significant size discrepancy. We admitted the patient for close observation and she started to labor upon immediate arrival. We were able to keep her pregnant until 29 weeks before she became pre-eclamptic. The surviving twins weighted 993 g and 1219 g. The acardiac triplet weighed in at just over 2500 g! The smaller of the 2 twins has been transported to Childrens Hospital here for necrotizing enterocolitis. She had 10 cm of intestine removed and 3 holes repaired. She is doing well though. The larger twin is doing well, nipple feeding. Neither baby was on a ventilator.

Postnatal image of placenta.  Baby "a" and "c" normal fetuses, baby "b" is the acardiac fetus.

The acardiac fetus: