Aoyagi Yoko, Kai Kentaro, Sumie Masahiro, Fujiyoshi Naoki, Furukawa Yuichi, Narahara Hisashi
Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital, Nakatsu, Japan.
Perinatal Care Center, Fukuoka Children's Hospital, Fukuoka, Japan.
SAGE Open Med Case Rep. 2019 Mar 14;7:2050313X19836342. doi: 10.1177/2050313X19836342. eCollection 2019.
The dissemination of minimally invasive in utero surgery reduced the mortality of twin reversed arterial perfusion sequence, but the mortality of expectantly treated surgical candidates remains high. A 26-year-old, non-parous, Japanese woman at 13 weeks of gestation had been diagnosed with twin reversed arterial perfusion sequence and was judged as a surgical candidate for radiofrequency ablation. However, she did not undergo surgery because of the anatomical location of the acardiac twin. At 18 weeks of gestation, the blood flow to the acardiac twin disappeared spontaneously. The pump twin began to demonstrate fetal growth retardation during the third trimester. The patient delivered a 1891 g female at term. We macroscopically identified the cause of the fetal growth retardation as velamentous insertion of the umbilical cord and microscopically diagnosed the acardiac twin with acardiac acephalus. We should give the same attention to the management of post-twin reversed arterial perfusion sequence as twin reversed arterial perfusion sequence itself.
微创宫内手术的推广降低了双胎反向动脉灌注序列的死亡率，但接受保守治疗的手术候选者的死亡率仍然很高。一名26岁、未生育的日本女性，孕13周时被诊断为双胎反向动脉灌注序列，并被判定为射频消融手术的候选者。然而，由于无心双胎的解剖位置，她没有接受手术。孕18周时，无心双胎的血流自发消失。泵双胎在孕晚期开始出现胎儿生长受限。该患者足月分娩一名体重1891g的女婴。我们在宏观上确定胎儿生长受限的原因是脐带帆状附着，并在微观上诊断无心双胎为无心无脑儿。我们应该像对待双胎反向动脉灌注序列本身一样，同样重视双胎反向动脉灌注序列后的管理。
