parabiotic

Twin B was structurally normal but had significantly increased amniotic fluid volume (polyhydramnios), and fetal echocardiography noted high-normal combined cardiac output due to the increased demands placed on the normal twin (pump twin) by the abnormal parabiotic twin.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010

They included termination of the pregnancy, continuation of the pregnancy without intervention allowing nature to follow its course with expectations of early delivery and possible cardiac complications in the pump twin, or interruption of the blood supply to the anomalous parabiotic twin using either bipolar cord cauterization or radiofrequency ablation of the blood supply.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010

Under epidural anesthesia a 3-mm skin incision was made, and with continuous ultrasound guidance, the RFA needle device was carefully directed to where the blood supply entered the abnormal parabiotic tissue mass.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010

After multidisciplinary consultation, the family requested selective bipolar umbilical cord cauterization of the abnormal parabiotic twin with transection (cutting) of the cord to reduce the risks associated with co-twin cord entanglement.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010

Following delivery of the normal twin, a small, and shrunken tissue mass, which had previously been the parabiotic twin, was passed without difficulty just prior to delivery of the placenta.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010

Selective bipolar umbilical cord cautery and transection of anomalous parabiotic twin The patient was a 33-year-old, second pregnancy, referred at 21 weeks gestational age for pregnancy complicated by a monochorionic, monoamniotic (single shared placenta, single shared amniotic sac) twin pregnancy, with one twin reported to have multiple congenital anomalies.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010

Follow-up evaluation showed normal fluid around the pump twin, no blood flow to or within the parabiotic tissue mass, significant decreased fluid around the abnormal fetus and normal cardiac function in the surviving pump twin.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010

Twin A’s features were consistent with an anecephalic/acardiac parabiotic twin with an abnormal two-vessel umbilical cord and reverse arterial and venous perfusion.

Twin Reversed Arterial Perfusion Sequence and Bipolar Cord 2010