August 2016 · Volume 5 · Issue 8 Page 2872 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Panchbudhe S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Aug;5(8):2872-2874 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Acardiac acephalus with malformed donor twin Shruti Panchbudhe*, Meena Satia, Lalita Kambhampatti INTRODUCTION Acardiac twins is a result of TRAP i.e. Twin reversed arterial perfusion seen in 1% of monochorionic twin gestation where one twin is structurally normal called the donor twin and a recipient twin which receives all its blood supply from the donor twin through its vascular connections on the surface of the placenta. 1 Twin Reversed Arterial Perfusion sequence also called TRAP sequence, TRAPS, or Acardiac twinning is a rare complication of monochorionic twin pregnancies. Acardiac twins has an incidence of 1 in 35000 pregnancies and it is a severe variant of twin-to-twin transfusion syndrome (TTTS). 1 In the recent years times the incidence has been reported to be higher which is probably attributed to assisted reproductive techniques which lead to an increase in multiple pregnancies and early detection by more and more first trimester ultrasound examinations. The Acardiac twin or TRAP fetus, is severely malformed with a missing or deformed heart, hence the name Acardiac, and the other twin is usually normal in appearance. The normal twin, called the donor twin, drives blood through both foetuses. It is called reversed arterial perfusion because in the Acardiac twin the blood flows in a reversed direction which leads to decreased growth of the upper torso and near normal growth of the lower parts. 2 Because the disorder is monozygotic, the twins are usually of same gender and females are usually more affected than the males. Early diagnosis and high clinical suspicion can offer treatment options like selective reduction of the parasitic twin in utero, allowing the donor twin to grow normally. CASE REPORT 21 year old female, married since 3 years, Gravida 2, Para1, Living1, came to the outpatient department for antenatal registration. She was 25 weeks of gestation by dates and 27 weeks of gestation by scan and she had an outside ultrasonography report suggestive of polyhydramnios of 29.5 cm and omphaocoele of 4 x 4 cm size. On examination patient was found to be 30 weeks per abdomen, with cephalic presentation and polyhydramnios without an appreciable fetal heart sound. Foetal viability scan showed live fetus. Patient was admitted for further evaluation. Her antenatal profile comprising of Haemoglobin 9.2 g/dl, Blood group was a positive, HIV, Hepatitis B surface antigen and VDRL were negative and she had received 2 doses of Tetanus toxoid injection. After admission her Oral glucose challenge test done for evaluating the cause of polyhydramnios in which the values were fasting, 1 hour and 2 hour values were 73, 93, 99 mg respectively, all of which were normal. She underwent a malformation scan at our tertiary care institution which showed a 4cm x 4cm sized defect in the anterior abdominal wall with Department of Obstetrics and Gynaecology, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India Received: 16 June 2016 Accepted: 06 July 2016 *Correspondence: Dr. Shruti Panchbudhe, E-mail: shrutipanchbudhe@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Some specific cases of Acardiac twins observed in remote parts of India where foetuses have been found to have extra limbs jutting out of chest cavity or abdomen have been given the specific and an attractive name of god baby. The present case under discussion is one such case where an Acardiac twin with Acephalus in the parasitic twin and malformed donor twin with multiple congenital anomalies incompatible with life delivered spontaneously at a tertiary care centre. Keywords: Acardiac twins, Acephalus, Parasitic twin DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162687