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Updated: Aug 25, 2026
Guide Wire Assisted Catheterization and Colored Dye Injection for Vascular Mapping of Monochorionic Twin Placentas
Published on: September 5, 2011
Monopolar thermocoagulation in the management of acardiac twins
Ping-Jian Chang1, Jui-Der Liou, Ching-Chang Hsieh
1Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan, ROC.
Objective:
To demonstrate the equipment setup and the application of monopolar thermocoagulation in the management of acardiac twins.
Methods:
We described 2 cases of acardiac acephalus twins who developed congestive heart failure and polyhydramnios at 20 weeks of gestation. A monopolar wire electrode was inserted through a 14-gauge trocar under ultrasound guidance. The inter-twin circulation was interrupted and confirmed by color Doppler flow examination.
Results:
Case 1 was detected at 20 weeks of gestation with progression to early signs of fetal congestive heart failure at 22 weeks. This case had smooth operative procedure and delivered a healthy infant at 32 weeks. Case 2 was referred at 24 weeks of gestation with marked fetal congestive heart failure. Although thermocoagulation cessed the inter-twin perfusion, the fetus died in utero 12 h later with persistent irreversible circulatory compensation.
Conclusion:
Monopolar thermocoagulation was an effective and generally available alternative technique to fetal endoscopic surgery for the interruption of vascular communication between acardiac twins.
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