Case Report of Autopsy and Placental Examination After Radiofrequency Ablation of an Acardiac Twin

We report the autopsy and placental findings in a monochorionic twin gestation complicated by twin reversed arterial perfusion (TRAP) sequence. Radiofrequency ablation (RFA) was performed at 24 weeks gestation to abort the acardiac fetus, and vaginal delivery of the co-twin and acardiac fetus occurred at 33 weeks gestation. An autopsy of the acardiac fetus revealed multiple congenital anomalies including complete absence of the upper extremities and poor development of the skull and facial structures. In contrast to the upper body, the lower half of the body, although malformed, was more developed. The monochorionic twin placenta showed velamentous, atrophied, proximal artery-artery and vein-vein intertwin vascular connections which essentially bypassed the placental parenchyma for the acardiac fetus. Ink injection and histologic examination confirmed thrombosis of these critical intertwin vascular connections after RFA. This report highlights the fetal and placental anatomy of TRAP sequence and stresses the importance of placental examination after fetal surgical techniques. * TTTS : twin-to-twin transfusion syndrome TRAP : twin reversed arterial perfusion A-A : artery-artery V-V : vein-vein RFA : radiofrequency ablation A-V : arteriovenous