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[Acardiac fetus]

C Faguer1, J Bonan, N Mulliez

  • 1Unité de Foeto-Pathologie, Hôpital Saint-Antoine, Paris.

Presse Medicale (Paris, France : 1983)
|September 14, 1996
PubMed
Summary

A rare condition called acardiac fetus, often seen in twin pregnancies, requires careful monitoring. Prenatal diagnosis and intervention can improve outcomes for the healthy twin, as spontaneous prognosis is often poor.

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Area of Science:

  • Perinatology
  • Medical Genetics
  • Reproductive Biology

Background:

  • Acardiac fetus is a rare, lethal condition in monozygous pregnancies.
  • Prenatal diagnosis via ultrasound is increasing, highlighting the need for therapeutic strategies.
  • The prognosis for the healthy twin is unfavorable in approximately 50% of cases without intervention.

Observation:

  • An acardiac fetus was diagnosed at 12 weeks gestation in a 36-year-old woman.
  • The healthy twin was monitored and delivered via cesarean section at 36 weeks, weighing 2.900 kg.
  • Post-delivery, the acardiac twin was found detached, weighing 16g, with a macerated appearance and syrenomelic features.

Findings:

  • Twin reversed arterial perfusion (TRAP sequence) is essential for the development of the acardiac twin.
  • The exact pathogenesis of acardiac fetus remains unknown, with genetic and immunologic theories proposed.
  • Clinical management decisions are based on the acardiac twin's development and risks to the healthy twin (e.g., heart failure, prematurity).

Implications:

  • Interventions like digoxin, selective extraction, or umbilical cord ligation may improve outcomes.
  • Therapeutic abstention is no longer recommended upon prenatal diagnosis of acardiac fetus with a healthy twin.
  • Early diagnosis and management are crucial for improving maternal and fetal survival rates in complex multiple gestations.

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