In general, twin pregnancy represents a high-risk pregnancy. The monozygous twin of all twin pregnancy is a real challenge for the obstetrician due to the severe complications that may arise during its development. An extremely uncommon, severe complication of monozygous twin pregnancy, which we recently experienced in Soonchunhyang University Cheonan Hospital, was a monochorionic diamniotic twin pregnancy with acardiac twin-twin reversed arterial perfusion sequence. An acardiac twin presented no heart, underdeveloped inferior part of the body, being transfused by the other fetus (pumping twin) by umbilical vessels. We report a 33-year-old pregnant woman, with a history of in vitro fertilization-embryo transfer in the second pregnancy, who presented with generalized edema, abdominal discomfort, and high blood pressure at 33 weeks' gestation. By ultrasonography, one of the babies is normally developed but in the other baby, head, upper extremities, and cardiac activity cannot be detected. The pumping twin was cardiomegaly, polyhydramnios, absent diastolic wave on the umbilical artery, and small for gestational age. We decided to terminate the pregnancy by primary cesarean section after administration of corticosteroids. The comprehension of this case is compulsory in order to provide maximum survival opportunity to the viable baby.
Adrenal Cortex Hormones ; Adult ; Cardiomegaly ; Cesarean Section ; Chungcheongnam-do ; Comprehension ; Edema ; Female ; Fetus ; Gestational Age ; Head ; Heart ; Humans ; Hypertension ; In Vitro Techniques ; Perfusion* ; Polyhydramnios ; Pregnancy ; Pregnancy, High-Risk ; Pregnancy, Twin ; Pregnant Women ; Twins ; Ultrasonography ; Umbilical Arteries ; Upper Extremity

Meigs' syndrome is a fibroma associated with ascites and/or pleural effusion and several cases have been reported in association with elevated serum cancer antigen (CA) 125 level. We report here on a 72-year-old woman who presented with palpable huge pelvic mass. Abdomen and pelvic computed tomography showed a heterogenous huge pelvic mass measuring 210×110 mm with large amount of ascites. No pleural effusion was detected on chest X-ray. CA 125 level was 327 IU/mL. The patient underwent laparotomy during which a mass measuring 210×110 mm was detected in her right ovary with 1,000 mL of ascites. Histology showed ovarian fibroma. We performed total abdominal hysterectomy with bilateral salpingo-oophorectomy. Postmenopausal woman with ovarian tumor, ascites, and elevated CA 125 may indicate malignant ovarian tumor, but Meigs' syndrome must be considered as differential diagnosis.
Abdomen ; Aged ; Ascites ; CA-125 Antigen ; Diagnosis, Differential ; Female ; Fibroma ; Humans ; Hysterectomy ; Laparotomy ; Meigs Syndrome* ; Ovary ; Pleural Effusion ; Thorax