A case of observing cardiac twins

Introduction. Reverse twin arterial perfusions, also known as cardiac malformation, is a uniquely rare complication of monochorionic multiple pregnancy due to the presence of a large arterio-arterial anastomosis, the formation of a rudimentary heart or its absence in one of the fetuses. The heart of a morphologically normal twin (fetus-pump, fetus-donor) provides blood circulation for both fetuses.

The aim of the work was to determine a possible way to reduce perinatal mortality using the clinical example of monochorionic multiple pregnancy with the presence of cardiac twins.

Materials and methods. Materials for clinical case analysis were the exchangenotification card of the pregnant and parenting woman, labor history, the results of functional and laboratory tests. Methods: analysis of anamnesis, results of functional and laboratory tests, peculiarities of pregnancy and delivery.

Results. The analysis successfully demonstrates the possibility of improving perinatal outcomes in monochorionic twins complicated by the presence of acardia syndrome in the case of timely diagnosis of the complication, close dynamic monitoring of pregnancy and timely delivery in the case of functionally confirmed deterioration of the living fetus.

Discussion. Monochorial type of placentation is recognized as a high risk factor for adverse perinatal outcomes (fetal-fetal hemotransfusion syndrome, the formation of discordant growth andfetal growth retardation, cardiac twins, increase frequency of preterm birth, perinatal morbidity and death). The presence of cardiac twins is the highest risk factor for antenatal death of a second fetus in the absence of timely surgical treatment and delivery. The presented clinical case demonstrates the possibility of improving perinatal outcomes by prolonging a multiple pregnancy complicated by cardiac malformation up to 33 weeks of gestation and delivery at decompensation of the placental complex.

Conclusion. In the vector of reducing the incidence of perinatal mortality, individual management of pregnant women with monochorionic multiple pregnancy is necessary to enable timely diagnosis of its complicated course by cardiac malformation of one of the fetuses, dynamic functional examination of the placental complex, determination of indications for surgical correction and choice of term of delivery.

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