title: Case Report of Autopsy and Placental Examination After Radiofrequency Ablation of an Acardiac Twin.
abstract: We report the autopsy and placental findings in a monochorionic twin gestation complicated by twin reversed arterial perfusion (TRAP) sequence. Radiofrequency ablation (RFA) was performed at 24 weeks gestation to abort the acardiac fetus, and vaginal delivery of the co-twin and acardiac fetus occurred at 33 weeks gestation. An autopsy of the acardiac fetus revealed multiple congenital anomalies including complete absence of the upper extremities and poor development of the skull and facial structures. In contrast to the upper body, the lower half of the body, although malformed, was more developed. The monochorionic twin placenta showed velamentous, atrophied, proximal artery-artery and vein-vein intertwin vascular connections which essentially bypassed the placental parenchyma for the acardiac fetus. Ink injection and histologic examination confirmed thrombosis of these critical intertwin vascular connections after RFA. This report highlights the fetal and placental anatomy of TRAP sequence and stresses the importance of placental examination after fetal surgical techniques.
authors.affiliation: Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Papreddy
authors.initials: P
authors.lastname: Kashireddy
authors.affiliation: Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Larson
authors.affiliation: Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lucy
authors.initials: L
authors.lastname: Minturn
authors.affiliation: Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois linda-ernst@northwestern.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Ernst
mesh_terms: D001344:Autopsy; D004200:Diseases in Twins / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal
keywords: acardiac twin; fetal laser coagulation; laser ablation; monochorionic twin; pathophysiology; twin reversed arterial perfusion (TRAP)