Doctors of MGM Healthcare treated a high-risk pregnant woman from Bangladesh with Twin Reversed Arterial Perfusion (TRAP) sequence or Acardiac twinning, in which one of the foetuses is anatomically normal and the other is an abnormal mass of tissue.
The 25-year-old woman, who has a bad obstetric history, approached the hospital when she was 20-weeks-pregnant with twins. “This was her fourth pregnancy. She had lost two infants within one or two days of delivery, and also had a miscarriage,” Vanitha Shri R., senior consultant, Obstetrics, Gynaecology and Fertility Specialist, VARAM, MGM Healthcare, told reporters on Wednesday.
‘50% mortality chance’
Doctors confirmed TRAP through a series of tests. “This occurs approximately in one in 35,000 pregnancies. It happens in identical twins,” she said. The abnormal foetus had no heart or head and is known as an “Acardiac twin”. The normal foetus is referred to as the “pump twin” as its heart is used to pump blood to the abnormal mass. If left untreated, there was a 50% mortality chance for the normal twin, she added.
Following this, Radio-Frequency Ablation (RFA) was performed at Mediscan, along with S. Sudarshan, fetal medicine specialist, Mediscan Systems, to stop blood flow to the Acardiac twin. The RFA device was placed in the Acardiac twin’s abdomen through the maternal abdomen and the uterus, and energy was deployed through the tip of the device, which cuts the vessels supplying blood of the Acardiac twin, according to a release.
Multiple complications
The woman had multiple complications, including auto-immune haemolytic anaemia, and developed a huge abscess in her lower abdomen, which ended in sepsis, altering her liver function.
She was taken up for an emergency caesarean section at 32 weeks of pregnancy and delivered a girl weighing 1.7 kg.
Binu Ninan, senior consultant Paediatrics and Neonatology, MGM Healthcare, said the baby was treated for jaundice and underwent an exchange blood transfusion.
The mother and the baby are doing well and all set to go home. Urjitha Rajagopalan, director, and Harish Manian, chief executive officer of the hospital, spoke.
