Iris Publishers- Open access Journal of Gynecology & Womens Health | Dichorionic Twin Pregnancy Discordant for Fetal
Anencephaly: A Case Report
Background: Anencephaly is a lethal diagnosis. In twin pregnancies discordant for anencephaly, there are risks of development of polyhydramnios, severe preterm delivery and death of an encephalic fetus.
Case presentation: A 30-year-old G 111 Para 11 both were vaginal delivery presented at Ian Donald ultrasound department for first time scan at 27-week gestational age. Ultrasound showed a live dichorionic, diamniotic intrauterine twin pregnancy. The Gestational age was 27 weeks and 5 days. A cranium of twin A was described. Polyhydramnios was noted for twin B at 29+5 weeks. After adequate obstetric, genetic counseling and given all the information about the risks involving this pregnancy, the parents opted for conservative management without any intervention.
Conclusion: The early diagnosis of anencephaly before 16 weeks’ gestational age in the twin decrease morbidity and mortality to the unaffected normal twin by providing the option of selective fetal reduction at an optimal gestational age.
Anencephaly is a lethal diagnosis. In twin pregnancies discordant for anencephaly, there are risks of development of polyhydramnios, severe preterm delivery and death of the anencephalic fetus [1].
The widespread introduction of ultrasound screening at 11+0 to 13+6 weeks of gestation allowed an earlier diagnosis of major fetal anomalies such as anencephaly [2-4]. Twin pregnancies present with a higher prevalence of anencephaly, with monochorionic twins having a higher incidence of discordance than dichorionic [5]. Twin pregnancies resulting from assisted reproductive treatments (ART) are particularly affected by this condition [6]. In dichorionic twins discordant for anencephaly, there are three management options: selective foeticide, serial ultrasound examination for polyhydramnios or expectant management [1]. In this case, the authors report a case of twin pregnancy discordant for anencephaly which was managed conservatively.A 30-year-old G 111 Para 11 both were vaginal delivery presented at Ian Donald ultrasound department for first time at 27 weeks. Ultrasound showed a live dichorionic, diamniotic intrauterine twin pregnancy. The Gestational age was 27 weeks and 5 days Acrania of twin A was described, based on the absence of the cranial vault and cerebral hemispheres. Polyhydramnios was noted for twin B at 29+5 weeks. At 29 weeks and 5 days both twins ware cephalic with estimated fetal weight 1.5 kilogram for twin A And 1.2 kilogram for twin B. After adequate obstetric and genetic counseling and given all the information about the risks involving this pregnancy, the parents opted for conservative management without any intervention.
One week later the patient presented with advance preterm labor and delivered the twins vaginaly.
At birth, twin A weighed 1.5 kilograms, with a normal physical exam. Twin B was anencephalic and weighed 1.2 kilograms. Apgar scores for twin A were 9 and 9 at 1 and 5 minutes. Apgar scores for twin B were 4 and 4 at 1 and 5 minutes.
Twin B expired 2 hours after birth. Autopsy and genetic analysis of twin B were declined. Twin A was dead after 7 days at hospital due to sepsis.
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