Obstetrics and Gynecology I - HASSAN II University Hospital – Fez- Morocco

Definition
Twin-reversed arterial perfusion sequence is a rare complication of monochorionic twin pregnancy in which an anomalous acardiac fetus is hemodynamically dependent on its structurally normal "pump" twin. in which a twin with an absent heart (‘acardiac twin’) is perfused by its co-twin (‘pump twin’) via placental arterial anastomoses. Prenatal diagnosis is suspected on first trimester ultrasound, when one fetus appears anatomically normal and the other lacks apparent cardiac structures. Definitive diagnosis is made when pulsatile flow is seen in the umbilical artery going towards the acardius. Early diagnosis is essential for improving perinatal prognosis for the normal twin. Fetuses with signs of high-output cardiac failure have poor prognosis and are candidates for intervention such as target occlusion of the umbilical cord of the acardiac twin, including laser ablation, bipolar cord coagulation or radiofrequency ablation.

Case reportA 34-year-old multiparous (gravida 4) woman at 10 weeks′ gestation. Ultrasound imaging showed a monochorionic-monoamniotic twin pregnancy with normal morphology and growth of the first twin and growth restriction of the second twin, with abnormal cephalic pole (acrania), no presence of cardiac activity and presence of retrograde perfusion in the umbilical artery. The parents decided to terminate of pregnancy.