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ABSTRACT: The fetus acardiac headless is a rare anomaly characteristic of twin monochromic pregnancies. Its frequency is 1/35000 births. Its evolution is constantly lethal for the affected fetus. The healthy fetus is exposed to a high risk of death in utero or complications. Among the different pathophysiological theories proposed, only the vascular theory is retained. Arterio - arterial and venous anastomoses are the source of vascularization against the current TRAP syndrome (Twin Reversed Arterial Perfusion disorder) of the abnormal fetus which receives the desaturated blood of oxygen and low in nutrients from healthy fetus.
KEYWORDS: acardiac headless, twin, fetus.
1 INTRODUCTION
The monochorionic twin pregnancies are characterized by the presence of vascular connections between the twins. These can be at the origin of pathologies as "Twin Reversed Arterial Perfusion Syndrome" which is defined as the combination of an acardiac, headless and a healthy twin. [1] This syndrome is very rare and is associated with high mortality of healthy twin anemia and heart failure. Antenatal diagnosis is possible for the establishment of appropriate monitoring and therapeutic means to interrupt the vascular anastomoses between the twins in order to achieve a selective feticide. Obstetric management varies between abstentionism and interventionist attitude that depends on the healthy twin prognosis dominated by prematurity and heart failure. We report a case of twin acardiac headless diagnosed during cesarean section which was done to the patient who was poorly followed during her pregnancy.
2 CASE PRESENTATION
Here we present a 25 years old female patient, gravida 1, Para 1, without medical or surgical history admitted in our department in labor. The patient was not followed during her pregnancy. She was transferred from a health center for better management of an obstructed labor.
On admission, Blood pressure was 120/70 mm Hg, pulse = 84 bpm, T° = 37.3°C, weight = 69kg, height = 162 cm.
On obstetrical examination fundal height was = 32cm, Uterine Contractions present, fetal heart beat present with severe bradycardia for the first twin, the other twin there was no cardiac beat. On vaginal examination, the patient was at full dilation, but the presentation was not engaged.
The ultrasound was not done because there was a technical problem.
The cesarean section was indicated in emergency and...