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Acardiac twin is a rare complication of monochorionic twin pregnancy. We present case of a 24 years-old primigravida with monochorionic pregnancy having an amorphous acardiac twin diagnosed during routine first trimester ultrasound scan. She was managed expectantly since there were no signs of hemodynamic compromise in the normal twin with close ultrasound fetal surveillance using gray scale and color Doppler ultrasound. Spontaneous regression of vascularity with reduced size of the acardiac twin was seen subsequently.

Background: Chorangioma is a benign vascular tumour of the placenta. Majority of tumours are small and incidental. Large chorangiomas (colloquially “giant chorangiomas”) are relatively uncommon. Case report: A primiparous woman, booked at an external institution, presented at 32 + 2 weeks of gestation with abdominal pain. Ultrasound scan showed a thick placenta and features worrisome for fetal anemia. The patient underwent emergency caesarean section in view of non-reassuring fetal status. At delivery, there was a large mass adherent to the placenta, raising the clinical possibility of an acardiac twin. Histopathological examination showed a singleton placenta and a multinodular proliferation of capillaries with nucleated erythrocytes, which established the diagnosis of a giant chorangioma with evidence of fetal anemia. Baseline investigations of the neonate showed anemia and thrombocytopenia, complicated by cardiomegaly and hepatomegaly. Conclusion: Although histologically benign, large chorangiomas may be associated with adverse clinical outcomes for the fetus. Given their large size, they may clinically masquerade as acardius amorphous, especially if antenatal history or follow up is limited or absent.

Twin reversed arterial perfusion syndrome is a rare obstetric condition that occurs in monochorionic twin pregnancies, resulting in coexistence of a normal “pump” twin and an acardiac twin. The acardiac twin is dependent upon the normal twin to provide circulation by means of vascular anastomosis, thereby putting the pump fetus at risk of high output cardiac failure. Overall only 50% of pump twins survive. Mortality for acardiac twin is 100%. We present a case of 26-year-old primigravida female presenting with 8 months of amenorrhea with unsure LMP. Ultrasonography followed by fetal MRI was carried out which revealed acardius acephalus twin with absence of blood flow in umbilical vessels. Pump twin had multicystic dysplastic left kidney with single umbilical artery. Following delivery, the pump twin survived well and the deformed fetus showed features of twin reversed arterial perfusion syndrome.

Acardiac twin or twin reversed arterial perfusion (TRAP) sequence is a rare medical complication of Monozygotic twins. Taiwanese Obstetricians usually treat TRAP sequence conservatively. Occasionally, repeated amnio-reduction is performed to decompress the polyhydramnios caused by the TRAP sequence, even though there was no correction of the pathophysiologic mechanism. Radiofrequency ablation is a minimally invasive, percutaneous technique that can effectively obliterate blood supply to an acardiac twin to preserve and protect the pump twin. This recent technique has never been used before for the treatment of the TRAP sequence in Taiwan. This article reported the first-hand experience of acardiac twin management with RFA in Taipei Chang Gung Memorial Hospital.

Objective: Twin-Reversed Arterial Perfusion (TRAP) sequence is a rare complication of monochorionic multiple gestation. Conservative management should be considered if there is no poor prognostic factor. Case report: This is a 35 year-old female with twin pregnancy with acardiac monster. Under the request of the patient, there was no intervention during the whole pregnancy. We keep regular and close sonography weekly follow up. There was no maternal complication and there was also no heart failure sign or polyhydramnios of the donor twin. Minimal blood flow was noted at the anastomotic vessels under the sonography at late gestational age. Due to breech presentation, cesarean section was performed at gestational age 37 + 1/7 weeks. She delivers a healthy baby smoothly. Conclusion: Antenatal sonography is an important tool to evaluate the fetus status. Under special condition, term pregnancy is still possible without any treatment. Case report: Twin reversed arterial perfusion syndrome in a monochorionic monoamniotic twin pregnancy.

Objective: Acardiac twin occurs in 1:35,000 pregnancies. Several techniques have been described to treat this condition. Some techniques have been suggested as golden standard; however, new are still being tried. Case report: This is a case of a 32-year-old patient who had successful ablation of the acardiac twin with Histoacryl. The diagnosis of the acardiac twin was made in the 11 weeks + 3 weeks of pregnancy. Due to the development of myocardial hypertrophy and pericardial transudate of the pumping fetus, we had performed ablation of the acardiac twin with Histoacryl in the 21 weeks' +5 weeks' gestation. The procedure was uneventful, and the healthy fetus had no signs of distress. In the 33 weeks' +5 weeks' gestation, she had Cesarean section due to distress of the healthy fetus. The female baby was healthy, weighing 2380 g, Apgar score 9/10. The mummified mass of acardiac fetus weighted 300 g. Nine months later, the child is doing well. Conclusion: Histoacryl is suitable for the ablation of an acardiac twin. Further studies are needed to prove the efficacy of this technique.