Monopolar thermocoagulation in the management of acardiac twins.
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.


CONCLUSIONS
Monopolar thermocoagulation was an effective and generally available alternative technique to fetal endoscopic surgery for the interruption of vascular communication between acardiac twins.
Chang
Ping-Jian
PJ
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taipei, Taiwan, ROC.
Liou
Jui-Der
JD
Hsieh
Ching-Chang
CC
Chao
An-Shine
AS
Soong
Yung-Kuei
YK
D000015:Abnormalities, Multiple; D000328:Adult; D001921:Brain / Q000002:abnormalities; D004564:Electrocoagulation / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D005313:Fetal Death; D005318:Fetal Heart / Q000002:abnormalities*; D005330:Fetofetal Transfusion / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006333:Heart Failure / Q000196:embryology / Q000209:etiology / Q000628:therapy; D006801:Humans; D006831:Polyhydramnios / Q000150:complications; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016216:Ultrasonography, Prenatal