Anencephaly is a frequent and easily diagnosed condition affecting twin pregnancies with higher incidence than singletons. Discordance for anencephaly in twins raises management dilemmas about the best approach to the situation. The authors report a successful case of a 33 years old woman who had a dichorionic twin pregnancy resulting from ICSI, with discordance for anencephaly. Diagnosis was performed at 13 weeks during first trimester ultrasound screening. A selective feticide with intrathoracic injection of KCl at 13 + 2 weeks was performed with no complications. The normal fetus proceeded with an uneventful pregnancy with spontaneous vaginal delivery at 40 weeks, weighting 3110 g. Management of twin pregnancies discordant for fetal anencephaly is far from being consensual. Two options are considered: selective feticide or expectant management, with serial ultrasound surveillance. In the latter option, amniodrainage or selective feticide may become options if polyhydramnios develops later in pregnancy. Therapeutic strategy requires an individual approach considering chorionicity, gestational age and all the risks of miscarriage, preterm labor and fetal demise to which these pregnancies are particularly exposed.
Cite this paper
Batista, J. , Raposo, L. , Sousa, A. and Cerveira, I. (2013) Discordance for fetal anencephaly in a dichorionic twin pregnancy: A case report. Open Journal of Obstetrics and Gynecology, 3, 541-543. doi: 10.4236/ojog.2013.37097.
 Souka, A.P. and Nicolaides, K.H. (1997) Diagnosis of fetal abnormalities at the 10-14 weeks scan. Ultrasound in Obstetrics & Gynecology, 10, 429-442.
 Jonhson, S., Sebire, N., Snijders, R., Tunkel, S. and Nicolaides, K. (1997) Ultrasound screening for anencephaly at 10 -14 weeks of gestation. Ultrasound in Obstetrics & Gynecology, 9, 14-16.
 Sebire, N., Sepulveda, W., Hughes, K., Noble, P. and Nicolaides, K. (1997) Managment of twin pregnancies discordant for anencephaly. British Journal of Obstetrics and Gynaecology, 104, 216-219.
 Bem-Ami, I., Edel, Y., Barel, O., Vaknin, Z., Herman, A. and Maymon, R. (2011) Do assisted conception twins have an increased risk for anencephaly? Human Reproduction, 26, 3466-3471. doi:10. 1093/humrep/der326
 Evans, M., Goldberg, J. and Dommergues, M. (1994) Efficacy of second trimester selective termination for fetal abnormalities: International collaborative experience among the world’s largest centers. American Journal of Obstetrics & Gynecology, 171, A1.
 Vandecuys, H., Avgidou, K., Surerus, E., Flack, N. and Nikolaides, K.H. (2006) Dilemmas in the management of twins discordant for anencephaly diagnosed at 11 + 0 to 13 + 6 weeks of gestation. Ultrasound in Obstetrics & Gynecology, 28, 653-658. doi:10.1002/uog.2836
 Lipitz, S., Meizner, I., Yagel, S., Shapiro, I., Achiron, R. and Schiff, E. (1995) Expectant management of twin pregnancies discordant for anencephaly. Obstetrics & Gynecology, 86, 969-972.
 Leeker, M. and Beinder, E. (2004) Twin pregnancies discordant for anencephaly—Management, pregnancy outcome and review of literature. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 114, 15-18. doi:10.1016/j.ejogrb.2003.09.013
 Lust, A., De Catte, L., Lewi, L., Deprest, J., Loquet, P. and Devlieger, R. (2008) Monochorionic and dichorionic twin pregnancies discordant for anencephaly: A systematic review of prenatal management options. Prenatal Diagnosis, 28, 275-279. doi:10.1002/pd.1967
 Rustico, M., Baietti, M., Coviello, D., Orlandi, E. and Nicolini, U. (2005) Managing twins discordant for fetal anomaly. Prenatal Diagnosis, 25, 766-771.
 Sepulveda, W., Wong, A., Sandoval, R., Aiello, H. and Otano, L. (2011) Monoamniotic twin pregnancy discordant for lethal open cranial defect: Management dilemas. Prenatal Diagnosis, 31, 578-582. doi:10.1002/pd.2751?
 Lim, K., Dy, C., Pugash, D. and Williams, K. (2005) Monoamniotic twins discordant for anencephaly managed conservatively with good outcomes: Two case reports and a review of literature. Ultrasound in Obstetrics & Gynecology, 26, 188-193. doi:10.1002/uog.1947