1993-07-07-13 Twin, acardiac, cephalic © Bala www.thefetus.net/
* Address correspondence to Kanu G. Bala, MBBS, FCGP Mina Laboratory, 98 New Elephant Road, Dhaka 1205, Bangladesh. Ph: 011-880-2-502-298
Companion case report
The following is submitted as a companion case to the previous and following cases because it demonstrates an interesting variance on the same subject (see Discussion).
A 25-year-old primigravida was first seen at 7 weeks of amenorrhea. On physical examination the uterus was non-palpable. At 12 weeks the uterus was found enlarged on physical examinationâ€” corresponding to a 16-week size. The patient was referred for ultrasound to exclude a twin pregnancy. On ultrasound, discordant- sized twins were found with BPD of 25 mm for the large twin and 16 mm for the other twin. No fetal heart movement was detected for the smaller twin, which was therefore considered to be dead. Aside from the presumed fetal demise, the smaller twin was apparently normal anatomically within the limits of the resolution of the ultrasound equipment used. The amniotic fluid was normal and there was no evidence of membrane between the gestational sac. The patient returned at 21 weeks and, on examination, the larger twin had increased appropriately (the BPD was now 57 mm) but surprisingly the presumed dead fetus had increased its BPD size from 16 to 38 mm. This was inappropriate growth for a live twin but was nevertheless remarkable. Again, on the second examination, no heartbeat was obtained. On the basis of the growth of the twin without cardiac activity, the diagnosis of twin reverse arterial perfusion syndrome was made. At 29 weeks the patient went into premature labor and delivered two dead fetuses.