ABSTRACT
Acardiac anomaly is a rare complication of multiple pregnancies. It is a hemodyamically disadvantaged nonviable twin which occurs in association with a twin reversed arterial perfusion sequence (TRAP). In TRAP, blood flows from an umbilical artery of the pump twin in reverse direction into umbilical artery of the perfused (or acardiac) twin via an arterial to arterial (AA) anastomosis. Its blood is poorly oxygenated and results in variable degrees of deficient development of the head, heart, and upper limb structures. The lower half of the body is usually better developed, which may be explained by the mechanism of perfusion. The pump twin is at risk of heart failure and problems related to preterm birth with a reported mortality of 50-75%. We present a case of multiple pregnancy with acardiac twin in a 26 year old lady with gestational diabetes mellitus. During ante natal check up several ultrasonographic (USG) screening showed twin pregnancy with one healthy fetus and the other fetus with inconspicuous anatomy and structure. Repeat USG at 36th week of gestation diagnosed twin pregnancy with acardiac twin. Strikingly the pump twin did not develop the usual complications and was delivered by cesarean section at 37th week of gestation.
ABSTRACT
Background: Premature rupture of membrane (PROM) is one of the common complications of pregnancy that has major impact on fetal and neonatal outcome. It is the commonest clinical event where a normal pregnancy becomes suddenly a high-risk one for mother and fetus or neonate. Objective: The study was undertaken to investigate whether raised fibronectin level in vaginal fluid may indicate premature rupture of membrane. Materials and Methods: This cross sectional study was conducted in the department of Obstetrics and Gynecology in Sir Salimullah Medical College & Mitford Hospital, Dhaka during the period of January 2006 to December 2007. A total of 114 pregnant women with gestational age 28th week up to 40th week were included. Sixty were PROM (Group I) and 54 were non-PROM (Group II) subjects. Fibronectin in vaginal fluid was measured by an immunochemical reaction by nephelometer. Statistical analysis was done by SPSS version 10.0. Results: The PROM patients had significantly higher concentration of fibronectin (225.77 ± 115.18 ng/mL) compared to that in non-PROM subjects (8.04 ± 16.17 ng/mL) (p < 0.001). Conclusion: It can be concluded that in cases of unequivocal rupture or intactness of the membranes, the result of the fibronectin test corresponds well with the clinical situation. So fibronectin is a sensitive test for detection of amniotic fluid in the vagina.