The management of acardiac twins: a conservative approach

Objective Optimal management of acardiac twin pregnancies is controversial. Data suggest a 50% mortality rate in the “pump” twin when the pregnancy is managed expectantly. Because of increased antenatal diagnosis, outcomes in expectantly managed cases may be better than reported. Our objective was to determine the outcome of expectantly managed acardiac twin pregnancies. Study design All cases of antenatally diagnosed acardiac twins delivered in our community between 1994 and 2001 were ascertained. All were managed expectantly. Perinatal outcome of pump twins was the primary outcome variable. Results Ten cases were identified. Nine women were delivered of healthy pump twins. There was one neonatal death. The mean gestational age at delivery was 34.2 weeks. The mean weights of the pump and acardiac twins were 2279 g and 1372 g, respectively. Conclusion Neonatal mortality of pump twins in antenatally diagnosed acardiac twin pregnancies may be considerably less than reported. Expectant management with close antepartum surveillance deserves consideration.