PubMed · 4574107
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K Benirschke, C K Kim. 1973-06-14. Multiple pregnancy. 1.. https://doi.org/10.1056/nejm197306142882406
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The acardiac fetus is a rare entity found only in monozygotic multiple pregnancy. Although the acardiac fetus is non-viable, the perinatal mortality rate for the normal fetus may be as high as 50 per cent, and is usually associated with fetal heart failure and hydrops fetalis, or as the result of prematurity. In this communication, we describe a case of spontaneous cessation of blood flow to an acardiac fetus and discuss the management of this condition with special reference to optimizing the outcome for the normal fetus.
The acardius syndrome is a rare complication of monozygotic twin pregnancies, occurring once in 35,000 births. The outcome is invariably fatal for the acardiac twin and for 50-75% of the normal twins. We present a surgical approach to the treatment of this problem involving hysterotomy and selective delivery of the acardiac twin, which we have used in five cases. In the first case, placental abruption shortly after the procedure led to fetal death. The next two cases resulted in cesarean delivery of the remaining healthy singleton at 35 weeks' gestation. The fourth and fifth cases were delivered at 27 and 28 weeks' gestation, respectively, the first because of preterm rupture of membranes 2 weeks after the procedure and the second because of partial placental abruption 8 weeks after surgery; both of these infants are now doing well. There were no residual maternal complications. We conclude that hysterotomy has direct applicability in the management of these high-risk pregnancies.