Ligation of the umbilical cord of an acardiac-acephalus twin with an endoscopic intrauterine technique.
BACKGROUND
Fetal acardia is a rare entity that complicates twin gestation. Reported survival of the normal or "pump" twin is below 50%. Perinatal mortality and morbidity typically result from heart failure in the pump twin caused by the circulatory demands of perfusion of the abnormal twin. Conservative management has not improved perinatal survival.


METHODS
A 30-year-old woman with a twin gestation at 18 weeks was diagnosed with acardia acephalus. Congestive heart failure of the pump twin led to an intrauterine endoscopic attempt to ligate the umbilical cord of the acardiac twin. Both twins ultimately died.


CONCLUSIONS
A variety of invasive techniques have been reported to accomplish occlusion of the acardiac twin's umbilical cord, with inconsistent results. Maternal morbidity was minimal and technical success was achieved with an endoscopic intrauterine technique of umbilical cord ligation. Despite the poor fetal outcome in this case, endoscopic ligation of the acardiac twin's umbilical cord should be considered for treating this unusual complication of twinning.
Department of Obstetrics and Gynecology, University of Arizona Health Sciences Center, Tucson.
C M
CM
McCurdy
J M
JM
Childers
J W
JW
Seeds
D000015:Abnormalities, Multiple / Q000601:surgery*; D000025:Abortion, Eugenic / Q000379:methods*; D000328:Adult; D001921:Brain / Q000002:abnormalities* / Q000601:surgery; D004200:Diseases in Twins; D004724:Endoscopy / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008026:Ligation; D011247:Pregnancy; D012886:Skull / Q000002:abnormalities* / Q000601:surgery; D014470:Umbilical Cord; D014599:Uterus