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P05.08: A case of fetal oropharyngeal immature teratoma

We present the case of a 32 year old para 1 woman pregnant with monochorionic twins. Acrania was diagnosed in one twin at at 12 weeks gestation in association with an absent stomach bubble. Both babies were karyotypically normal. This pregnancy was later complicated by twin–twin transfusion syndrome (TTTS) with the affected fetus as the donor. This combination confounded both the diagnosis and grading of severity of TTTS as a lack of swallowing by the acranial donor twin led to normal amniotic fluid volume measurements. An assessment of twin to twin transfusion was therefore made purely on the basis of Doppler ultrasound. After referral to the tertiary centre selective laser coagulation of the placental vessels and cord was done with the demise of the anencephalic donor twin. At 30 weeks gestation spontaneous precipitate labour ensued with a first stage lasting only 25 minutes, and resulting in the birth of a live 1270 g female infant. Apgar scores were low at delivery and the baby was transferred to the intensive care baby unit. The main problem of twins discordant for acraniaanencephaly was reduced following laser treatment with salvage of the normal twin in this case. The concerns are that preterm birth risk appears unchanged generally despite improved care. There is currently no universally agreed policy for managing this condition in monochorionic twins. There is therefore a need for multi-centred studies to help maximise survival of the normal twin and prevent majore morbidity.