Twin reversed arterial perfusion sequence in conjoined, acardiac, acephalic twins associated with a normal triplet. A case report

BACKGROUND: Twin reversed arterial perfusion (TRAP) sequence and development of an acardiac monster is a rare event. Even more rare are conjoined acardiac, acephalic twins complicating a triplet pregnancy with TRAP sequence. The mortality for the acardius is 100%, and morbidity for the normal, pump fetus is 50%. The morbidity of the pump twin or triplet is attributed mostly to in utero congestive heart failure. CASE: A 24-year-old woman, gravida 1, para 0, at 35 weeks' intrauterine pregnancy, gave birth via low transverse cesarean section to a normal female and a pair of conjoined, acardiac, acephalic, pelvipagus twins. CONCLUSION: The diagnosis of acardius in multiple gestation pregnancy, with no fetal heart tone on ultrasound, must be ruled out in every case so that proper counseling, management and avoidance of complications in these patients can be achieved.