TWIN PREGNANCY WITH

ACARDIAC TWIN
Final Year MBBS
Batch A
 HISTORY
• Dua Imran, W/O Imran, 24 years old
• Educated to intermediate
• Resident of Bahria Town Lahore
• Married for 1 year
• G2P0A1
• LMP: 17-11-21
• EDD : 24-08-2022
• Monochorionic Diamniotic Twin with one anomalous twin.
• DOP 33 +5 weeks
• DOA : 11-7-22
• MOA : OPD
 PRESENTING COMPLAINT

• Monochorionic Diamniotic twin

• DOP: 33+5 weeks
• Decreased fetal movements 3 days
 HISTORY OF PRESENTING COMPLAINTS
• My patient is known case of having Monochorionic Diamniotic
twins
• On anomaly scan done at 20 weeks , one twin
was diagnosed with Hydrops fetalis and Cystic Hygroma

She presented with decreased fetal movements for last 3 days

and was admitted for fetomaternal monitoring ,
investigations and further management.
HISTORY OF PRESENT PREGNANCY
• 1st Trimester:
 She conceived spontaneously, confirmed by
UPT at home. Dating scan was done which
showed
 Monochorionic Diamniotic twin pregnancy.
 She did not take folic acid
 She gives history of excessive nausea and
vomiting
 HOPP contd…….
• 2nd Trimester
• She took Iron and calcium regularly
• Anomaly scan was done at 20 weeks which showed
one twin with hydrops fetalis and cystic hygroma .
• Patient and family were informed about the
findings
• Quickening started at 6th month of gestation
• No History of hypertension or diabetes in this
pregnancy
 HOPP contd…….
• 3rd Trimester
• She continued taking iron and calcium
• Her growth scan at 29 weeks showed that
anomalous twin was dead with generalized
anasarca and soft tissue thickness of abdomen
• The other twin showed parameters of 30 weeks
and EFW of 1.4kg with absent fetal body
movements and scanty amniotic fluid AFI of 4-
5cm
 OBSTETRICAL HISTORY

• MF 1 Year
• G2P0A1
• Previous 1 spontaneous miscarriage
 GYNECOLOGICAL HISTORY

• Age of Menarche 12 years

• Menstrual cycle 4-5/28 and regular
• No history of dysmenorrhoea
• Dyspareunia
• IMB or PCB
• Pap smear was never taken
• No contraception
PAST MEDICAL AND SURGICAL HISTORY

• No history of diabetes, hypertension , asthma,

gynaecological malignancy or TB
• No history of any surgery in the past
 FAMILY HISTORY

• Mother is hypertensive
• Father Diabetic
• No family history of twins or triplets
PERSONAL AND SOCIOECONOMIC HISTORY

• House wife , educated, non- smoker ,no History of

addiction to drugs.
• She belongs to middle class family
• She lives in her own house with 6 family members
• Basic necessities of life available
 EXAMINATION
• GPE :
A young lady lying in bed comfortably and is well oriented in time
place and person
VITALS
• BP: 110/70 mm Hg
• Pulse: 78/ min, regular rhythm and volume
• SPO2: 98 %
• Temp : normal
• R/R : 16 breaths/min
• No anaemia , jaundice , koilonychia clubbing or palmer
erythema
 SYSTEMIC EXAMINATION
• Respiratory system:
Bilateral vesicular breathing
No added sounds
• CVS:
S1 + S2 + 0
• CNS:
Grossly intact
• Breast Examination was normal
• Accessible lymph nodes not palpable
• Thyroid not enlarged
 ABDOMINAL EXAMINATION
• INSPECTION
Protrubrent abdomen,umbilicus central and flat,stria
gravidarum visible, no prominent pulsations or scar marks
• PALPATION
Abdomen was soft
SFH: 32cm,multiple fetal parts palpable
• AUSCULTATION
Fetal heart sounds of one twin audible
 INVESTIGATIONS
Blood group:
 B +ve
• CBC:
 Hb % : 11 gm/dl
 Platelet: 283000/mm3
 WBC count: 9000/mm3
• BSR: 90mg/dl
• HbsAg: negative.
• Anti-HCV antibodies: negative
• HIV: negative.
• PT : 13 seconds APTT : 32 seconds
INR : 1
 Anomaly scan
• Monochorionic Diamniotic twin
• Both twins alive
• Amniotic fluid normal in 1st twin and
polyhydramnios in 2nd twin (AFI : 29-30cm)
• Gestational age 20 weeks
• 2nd twin has body oedema ,pleural effusion
and abdominal ascities, hydrops fetalis, cystic
hygroma
ANOMALY SCAN
 Growth Scan AT 30 weeks
• MCDA twin pregnancy
• Placenta fundal
• Twin 1 alive and healthy with gestational age
of 30 weeks, EFW 1.4 Kg
• Twin 2 was IUD AT 25 Weeks
Scan at 29 weeks
 Scan on Admission(35weeks)
• MCDA twins
• Twin 1 alive ,breech presentation, gestational
age of 30 weeks, AFI 4-5cm with absent fetal
body movements, EFW 1.4kg
• Twin 2 was IUD with generalized anasarca
 MANAGEMENT
• Emergency caesarean section done
• Outcome
• Twin 1 ,Female baby, 1.3kg, died after 24
hours
• Twin 2 grossly anomalous, gender not
identified, only 2 fetal poles identified. It was
Acardiac twin.
Acardiac Twin