Twin Reversed – Arterial Perfusion Sequence: The Experience of a Tertiary Referral Hospital in the Philippines with Acardiac Twinning

Twin reversed-arterial perfusion sequence is a rare complication ofmonochorionic pregnancies. It is characterized by the hemodynamicdependence of the recipient twin on a pump twin. The recipient twinexhibits lethal malformations. The pump twin’s survival is threatenedby congestive heart failure and prematurity. Mortality rate rangesfrom 50% to 75% if untreated. Mortality is reduced to 13.6% withsurgical intervention.1Five cases of twin reversed-arterial perfusionsequence were seen in the Philippine General Hospital, a universityhospital and tertiary referral center. All cases had acardiac twins andwere managed conservatively. The first three cases were previouslyreported. Two additional cases were encountered in 2007-2008 andare here presented. The first case was in a 41 year old G8P7 (7007) withdiffuse toxic goiter and hypertension. The pregnancy was plaguedwith polyhydramnios and cardiac decompensation of the pump twinresulting in fetal death- in-utero. The second case was in a 37 year oldG3P2 (2002) who had no medical co-morbidities. There were no riskfactors and the outcome was a term livebirth