Acardius- acephalus Twin Delivery: A Case Report and Review of Literature

We present a case of a 27 year old primigravida at 36+6 weeks gestation with monochorionic diamniotic twin gestation who presented late in pregnancy with twin reversed arterial perfusion (TRAP) sequence and a diagnosis of severe preeclampsia. Twin reversed arterial perfusion syndrome is a very rare manifestation of twin to twin transfusion in a monochorionic gestation where the affected twin receives vascular supply in a retrograde manner from the healthy twin. The antenatal period was poorly supervised due to the temporary closure of our centre. She had her first ultrasound scan at 15 weeks but TRAP sequence was not noted. She was delivered via an emergency lower segment caesarean section. The donor twin is currently doing well. This case underscores the need for proper training and recertification of Fetal Medicine Specialists for accurate and early diagnosis so that the Obstetrician will be fully prepared for all eventualities.