Acardiac twin - A case report

Acardiac twinning is a rare congenital anomaly of monozygotic twin pregnancy which often results from abnormal placental vascular anastomosis. It leads to twin reversal arterial perfusion with complex pathophysiology. Current information on early recognition and treatment for salvation of the normal twin is based on individual case reports in the literature. Mortality of Acardiac twin is 100%. Pump twin though structurally normal suffers due to heart failure and prematurity and has high morbidity and mortality all due to pumping blood to the acardiac twin. The acardiac twin receives all its blood supply from the pump twin through anastomotic channels, the term reversed perfusion is used to describe this condition because blood enters the acephalic twin through umbilical artery and exit through umbilical vein which is opposite to the normal blood supply. The acardiac twin loses direct vascular connection with the placental villi and receives its entire blood supply from the pump twin. Here, we have presented a primigravida of 24-26 weeks of gestation with twin gestation of monochorionic diamniotic type in preterm labor. One of the twin was acardiac acephalous and another a pump twin with hydrops.