A rare presentation of aplasia cutis congenita after feto-reduction in a trichorionic-triamniotic pregnancy.
Aplasia cutis congenita (ACC) is rare skin disorder of newborns that has been linked to both assisted reproductive technology (ART) and feto-reduction procedures. ACC is characterized by well-demarcated lesions that are devoid of all skin layers. Group-V ACC presents with a distinctive and symmetrical distribution pattern. It is thought to result from an insult to the fetus after concomitant twin demise and is almost exclusively reported in monochorionic gestations.A 41-year-old female with an in vitro fertilization (IVF) assisted tri-chorionic gestation subsequently underwent selective feto-reduction of Fetus C. The patient delivered two pre-term neonates secondary to pre-eclampsia. The initial exam of Twin B showed extensive, well-demarcated, symmetrical areas devoid of any skin over the anterior and lateral trunk, extending up the lateral thoracic walls. Chest and abdominal viscera were visible through a thin fibrous membrane. The skin defects were managed conservatively with twice-daily dressings of Aquaphor, and Vaseline gauze. The areas of aplasia slowly contracted, though residual scarring was noted. After four weeks in the NICU, most of the areas were healed.ACC in multi-fetal pregnancies is a rare, but well-described complication. This is, to our knowledge, the first reported case in a tri-chorionic IVF gestation after feto-reduction. With increased incidence of ART-associated pregnancies and the use of feto-reduction for higher order gestations, this may become more common. Neonates often require specialized intensive care. Conservative management usually will suffice, although surgical grafting may be required. Physicians should be aware of this condition and counsel their feto-reduction patients of the risk.
Pinnacle Health Medical Group, Maternal Fetal Medicine, Harrisburg, PA, USA.
D J
DJ
Vettori
Department of Pediatrics (Neonatal Division), Pinnacle Health/Pediatrix Medical Group, Harrisburg, PA, USA.
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P
Jairath
D000328:Adult; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004200:Diseases in Twins; D004476:Ectodermal Dysplasia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009779:Occlusive Dressings; D010577:Petrolatum / Q000627:therapeutic use*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects; D016896:Treatment Outcome
D003879:Dermatologic Agents; D010577:Petrolatum
Aplasia cutis congenita; feto-reduction; in vitro fertilization; multi-fetal pregnancies; neonatal skin disorders