Chanthasenanont Athita, Pongrojpaw Densak
Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
J Med Assoc Thai. 2007 Apr;90(4):819-22.
The authors present a case of an acardiac twin gestation diagnosed sonographically at 20 weeks with evidence of twin reversed-arterial perfusion (TRAP) sequence. The acardius appeared to be less than half the estimated weight of the pump twin. The acardius was identified as an amorphous mass, without extremities. The parents chose expectant management rather than surgical intervention. Observation by serial sonographic and color Doppler evaluation was performed. At 34 weeks, a healthy infant was delivered by cesarean section after showing signs of fetal congestive heart failure (CHF). The acardius was 2/3 the size of the infant at delivery.
Expectant management with close antepartum surveillance deserves consideration in cases of monozygotic twins with TRAP sequence. Neonatal mortality of the pump twin diagnosed antenatally may be considerably less than reported.
作者介绍了一例孕20周时经超声诊断为无心双胎妊娠的病例，有双胎反向动脉灌注（TRAP）序列的证据。无心儿的体重似乎不到泵血双胎估计体重的一半。无心儿被识别为一个无定形肿块，没有四肢。父母选择期待治疗而非手术干预。通过连续超声和彩色多普勒评估进行观察。孕34周时，在出现胎儿充血性心力衰竭（CHF）迹象后，通过剖宫产分娩出一名健康婴儿。无心儿的大小为分娩时婴儿的2/3。
对于患有TRAP序列的单卵双胎病例，值得考虑进行期待治疗并进行密切的产前监测。产前诊断的泵血双胎的新生儿死亡率可能远低于报道的水平。
