Ultrasound imaging of acardia twin before and after blood spontaneously blocked and pump twin′s outcome analysis in twin reversed arterial perfusion sequence / 中华医学超声杂志（电子版）

ABSTRACT

Objective To discuss the ultrasound imaging of acardia twin before and after spontaneously blood blocked in twin reversed arterial perfusion sequence (TRAP), and to analyze the inlfuence factor for the prognosis of pump twin. Methods Seven TRAP with pump twins and acardia′s blood lfow blocked were diagnosed by US and autopsy in Hubei Women and Children′s Hospital between 2001 January to 2012 September. The ultrasound images, clinical data and pump twin’ outcome were analyzed. Results Ultrasound images showed skin edema, acardia, spine and lower limbs in seven acardia cases before blood blocked, among which 4 were acardius acephalus, 3 were acardius anceps. Single umbilical artery were detected in 7 cases with reversed umbilical artery perfusion toward fetus. Four cases had rare blood lfow (UA-PI ratio<0.7. Five acardia cases had slower growing rate than the pump twin. Ultrasound images showed no growing, no blood lfow in the acardia, the acardia twin became vagued in the second and third trimester, and ifnally developed into a paper fetus. A linear umbilical cord extend from umbilical region to placenta were found in 7 cases whose blood lfow were spontaneously blocked. Pump twin′s outcome:3 pump twins survived, 3 died in uterus, and 1 was induced labor due to hydrocephalus and cardiac failure. The most important factors that affected the prognosis of pump twin includedfaster growing in acardia twin with less blood supply, abnormal brain and heart function in pump twin, chromosome abnormalities, abnormal amniotic fluid and cord entanglement. Conclusions Less blood flow and slow growth speed prompt in acardia twin suggested spontaneously acardia blood block. It is mandatory to monitor the pump twin after the spontaneous block of acardiac’s blood lfow.