Is it correct to trust each ultrasonography report blindly? a case report on misdiagnosis, diagnosis and management of acardiac twin pregnancy


  • Pooja Chandak Department of Obstetrics and Gynecology, Toshniwal Chest Hospital and Maternity Home, Nanded, Maharashtra, India
  • Shobha Toshniwal Department of Obstetrics and Gynecology, Toshniwal Chest Hospital and Maternity Home, Nanded, Maharashtra, India



Acardiac twin pregnancy, Fetal medicine expert, Ultrasonography


Multifetal gestation is often a high-risk pregnancy and especially the monochorionic twin pregnancy significantly contributes to fetal morbidity and mortality. Acardiac twinning, earlier known as chorioangiopagus parasiticus, is the most extreme manifestation of this condition. An acardiac twin is a rare complication of multifetal pregnancy, in the literature reported at an incidence of 1% of monochorionic twin pregnancies, i.e. 1 of 35,000 pregnancies. Often results from abnormal placental vascular anastomoses. This leads to twin reversal arterial perfusion with complex pathophysiology. Here authors present a case of acardiac twin pregnancy presented at 26 weeks with the ultrasonography report suggested?? Placental teratoma of size 11×11×13 cm with polyhydramnios as there was no reason to suspect something else as the picture described in the USG report with the polyhydramnios was fitting with the diagnosis of placental teratoma but as the scan was done at taluka place and the images provided were not clear authors decided to confirm the diagnosis from fetal medicine specialist as MTP was not the option for the patient as she was 28 weeks who confirmed that as a case of acardiac twin pregnancy and the case was managed accordingly.


Hrubec Z, Robinette CD. The study of human twins in medical research. N Engl J Med. 1984;310:435-41.

Sogaard K, Skibsted L, Brocks V. Acardiac twins: pathophysiology, diagnosis, outcome and treatment. Six cases and review of the literature. Fetal Diagn Ther. 1999;14:53-9.

Cunningham FG, Grant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD. Williams Obstetrics. 21st ed. New York: McGraw-Hill; 2001:783-784.

Pinet C, Colau JC, Delezoide AL, Menez F. Acardiac twins. Les jumeaux acardiaques. J Gynecol Obstet Biol Reprod. 1994;23:85-92.

Hanafy A, Peterson CM. Twin-reversed arterial perfusion (TRAP) sequence: case reports and review of literature. Aust N Z J Obstet Gynaecol. 1997;37:187-91.

Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol. 1990;163:907-12.

Ishimatsu J, Nakanami H, Hamada T, Yakushiji M. Color and pulsed Doppler ultrasonography of reversed umbilical blood flow in an acardiac twin. Asia Oceania J Obstet Gynaecol. 1993;19:271-5.

Al-Malt A, Ashmead G, Judge N. Color- flow and Doppler velocimetry in prenatal diagnosis of acardiac triplet. J Ultrasound Med. 1991;10:341-5.

Sepulveda W, Sfeir D, Reyes M, Martinez J. Severe polyhydramnios in twin reversed arterial perfusion sequence: successful management with intrafetal alcohol ablation of acardiac twin and amniodrainage. Ultrasound Obstet Gynecol. 2000;16:260-3.

Tan TYT, Sepulveda W. Acardiac twin: A systematic review of minimally invasive treatment modalities Ultrasound Obstet Gynecol. 2003;22:409-19.

Weisz B, Peltz R, Chayen B, Oren M, Zalel Y, Achiron R, et al. Tailored management of twin reversed arterial perfusion (TRAP) sequence. Ultrasound Obstet Gynecol. 2004;23:451-5.






Case Reports