Extremely rare case of Acardiac twins successfully treated, delivered in Pune

IN what represents a rare case around the world, Anju (name changed), a 36-year-old woman, was treated for acardiac twins in Pune. She and her husband exhibit primary infertility and had been unable to conceive for 10 years due to underlying conditions in both of them. Anju had a swelling in her womb (called adenomyosis), a poor endometrium, and her husband’s semen lacked a healthy and adequate number of sperms. 

The couple approached an in vitro fertilisation (IVF) clinic in Pune where they underwent a successful cycle of IVF using advanced reproductive techniques. Anju conceived in the first attempt with a twin pregnancy, but her pregnancy was challenged by a very rare case of acardiac twins.  Acaridiac twins can be spotted with regular monitoring in the early months of the pregnancy with the help of foetal ultrasonography using Doppler.

Elaborating on this rare case, Dr Amol Lunkad, Chief IVF Specialist at Indira IVF Pune where the procedure was conducted said, “Acardiac Twins, also known as ‘TRAP sequence’, is a very rare condition of conjoint twin pregnancies in which one twin does the work of supplying blood for both twins. The twin supplying blood is known as ‘pump twin’ while the other twin is known as ‘acardiac twin’. The acardiac twin lacks a heart and has a mortality of 100 per cent. The incidence of such pregnancies is very rare and occurs one in 40,000 births.

The primary objective in such cases is to save the normal baby (pump twin) as both the babies have a common placenta, the tissue responsible for the exchange of substances between the mother and child. If timely intervention is not performed, then there is a probability of losing the normal baby to heart failure due to excess of pumping of the organ. Discontinuation of blood supply to the abnormal acardiac twin without affecting the normal baby and proper continuation of the pregnancy thereafter is a great challenge. 

Dr Amit Magdum and Dr Ramesh Gaikwad, who were involved in the team of specialists treating Anju, highlighted that developments in medical technology such as advanced intrauterine foetal therapy using laser coagulation have made treatment of such complex cases possible. The procedure that helped save the normal baby’s life was carried out at 14 weeks and 2 days in Indira IVF Pune. 

After intrauterine foetal therapy, such patients must be taken special care of because they tend to have a premature delivery. In this case, Anju was also regularly monitored as she has diabetes. Her pregnancy carried through full-term, and she and her husband are now parents to a healthy baby who was born a few days ago in January.

“Proper and early diagnosis, along with advanced treatment performed at the right time enabled us to save this precious life. Previously, such procedures were not performed in Pune, and patients had to travel far and wide to Mumbai or Bangalore to get treated. However, with better availability of advanced technology and more experts, it is now possible to timely help out such rare pregnancy conditions in the city itself. More awareness of such intrauterine foetal therapies is required as couples are often afraid, apprehensive, and confused. Proper counselling is, thus, essential. Successful treatment of such cases is definitely a ray of hope for many more precious but complicated pregnancies,” added Dr Lunkad.

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