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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
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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.

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.

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  • 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.