Acardiac Twin: A Case Report

Acardiac twinning, or twin reversed arterial perfusion (TRAP) sequence, is a rare anomaly of monochorionic twins with an incidence of 1 in 35,000 births. We report a case of a 35-year-old G2P1L1 woman, previously diagnosed with singleton pregnancy during rural ANC visits, presented at 22+1 weeks of gestation whose detailed ultrasound revealed a twin pregnancy with a normal twin and a malformed twin with hydrops, caudal regression and rudimentary limbs, confirmed by MRI. After counseling on risks and options, the family opted for termination. Induction with mifepristone and misoprostol delivered a 560g normal male fetus and a 300g malformed acardiac mass with an identifiable limb sharing a single placenta, consistent with acardius myelacephalus. This case underscores the need for early determination of chorionicity and careful ultrasonographic assessment in twin pregnancies to enable timely intervention and improve pump twin outcomes in resource-limited settings.