Chorongiopagus Parasiticus: Monster in Utero
Chorangiopagus Parasiticus: Monsters in Utero
An interesting case presentation
Kristine G. Inocencio, MD, Medical Officer III
Department Of Obstetrics and Gynecology
Quirino Memorial Medical Center,
Quezon City, Philippines
Submitted for review May 2007
ABSTRACT
We report a case of twin gestation (diaamnionic-monochorionic) in which one of the twins had no head and poorly developed upper trunk. The co-twin appears grossly normal and both twins were stillborn. This condition is known as holoacardius or acardiac anomaly; it is a rare type of fetal twin-to-twin transfusion with an incidence of approximately 1 in 35000 births. This anomaly is thought to result from an umbilical artery-to-artery anastomosis between twin fetuses referred to as the TRAP (twin-reversed arterial perfusion) syndrome. Acardiac fetus is a rare complication of multifetal pregnancy and is incompatible with life, in most cases, a lethal condition for both the pump and parasitic twin. The mortality rate of the normal twin when an acardiac twin is present falls between 50-100%. The pathogenesis is still unknown, and recurrence has not been reported due to its rarity. It is important to be familiar with its pathologic features and classification in order to be able to perform the appropriate prenatal counselling and surveillance since such a condition can be diagnosed as early as the 12th week of gestation. Although there are no proposed guidelines for its management, the technology and the ethical implications of removing the parasitic twin in this country poses a challenge in its management. Careful post-mortem and placental examination is warranted for proper diagnosis and subsequent pregnancies are closely monitored.
INTRODUCTION
Chorangiopagus parasiticus, also referred to as: acranius–acardius, acardiac monster, acephalus, pseudocardiac, anomaly, acephalus acardia and holocardius is a rare and serious complication of twin gestations and occurs as a consequence of
An interesting case presentation
Kristine G. Inocencio, MD, Medical Officer III
Department Of Obstetrics and Gynecology
Quirino Memorial Medical Center,
Quezon City, Philippines
Submitted for review May 2007
ABSTRACT
We report a case of twin gestation (diaamnionic-monochorionic) in which one of the twins had no head and poorly developed upper trunk. The co-twin appears grossly normal and both twins were stillborn. This condition is known as holoacardius or acardiac anomaly; it is a rare type of fetal twin-to-twin transfusion with an incidence of approximately 1 in 35000 births. This anomaly is thought to result from an umbilical artery-to-artery anastomosis between twin fetuses referred to as the TRAP (twin-reversed arterial perfusion) syndrome. Acardiac fetus is a rare complication of multifetal pregnancy and is incompatible with life, in most cases, a lethal condition for both the pump and parasitic twin. The mortality rate of the normal twin when an acardiac twin is present falls between 50-100%. The pathogenesis is still unknown, and recurrence has not been reported due to its rarity. It is important to be familiar with its pathologic features and classification in order to be able to perform the appropriate prenatal counselling and surveillance since such a condition can be diagnosed as early as the 12th week of gestation. Although there are no proposed guidelines for its management, the technology and the ethical implications of removing the parasitic twin in this country poses a challenge in its management. Careful post-mortem and placental examination is warranted for proper diagnosis and subsequent pregnancies are closely monitored.
INTRODUCTION
Chorangiopagus parasiticus, also referred to as: acranius–acardius, acardiac monster, acephalus, pseudocardiac, anomaly, acephalus acardia and holocardius is a rare and serious complication of twin gestations and occurs as a consequence of