![]() ![]() One of the early cases of superfetation was described in 1992 showing dichorionic diamniotic twins with a 4-week size and consistent growth difference shown through ultrasound measurements. This is rare in humans with less than 10 cases of superfetation are described in the literature. According to previous research, the diagnosis of superfetation is suspected when there is a growth discrepancy in a multiple pregnancy. Superfetation is a rare phenomenon that occurs when a second ovum is fertilized after there is already presence of a fetus in the uterine cavity. We feel this case demonstrates human superfetation. He also had more feeding issues than Twin A and was discharged with a G-Tube for supplemental feedings at home. He went home on 2 liters nasal cannula oxygen at night. When that change was made his NICU course was typical for a "25-week baby". At that time, the NICU team started to treat him like a 25-week baby by slowing down ventilator weaning and giving him more time grow. ![]() The NICU doctor told the patient, "he is acting like a 25-week baby with his NICU course instead of a 28-week-old baby". He was more difficult to ventilate and more difficult to wean off the ventilator. ![]() The NICU doctor told the patient that, "her NICU course was like a normal 28-week baby". She was treated for reflux and feeding issues. Twin A neonatal intensive care (NICU) course was 160 days. Both were treated with surfactant at delivery. Twin A was 965 grams, and a female and Twin B was 575 grams, and a male. Daily non-stress tests were performed and at 28 weeks and 3 days the twins were delivered by Caesarean section for non-reassuring fetal status. The patient was admitted to the hospital at 27 weeks and 5 days for daily fetal observation. Graph 2: % discordance from serial ultrasounds between Twin A and Twin B is shown above. She was offered amniocentesis but declined at that time. According to the patient, the possibility of her high-risk cfDNA being a result of her missed twin pregnancy diagnosis and not fetal triploidy was not discussed with her. The patient was advised to terminate the pregnancy due to fetal triploidy concerns for Twin B due to fetal growth restriction at such an early stage and her high-risk result cfDNA test. Ultrasound showed an undiagnosed twin gestation Twin A measuring 18 weeks and 6 days and Twin B at 17 weeks and 2 days. No further ultrasounds were preformed until 19 weeks.Īt 19 weeks and 2 days, the patient had a consult at a tertiary care facility with a maternal fetal medicine (MFM) physician for advanced maternal age and her high-risk cfDNA test. The report suggested this was due to either a vanishing twin, unrecognized multiple gestation or increased risk of fetal triploidy. Cell-free DNA is a serum-based screening test for aneuploidies using analysis of cell-free DNA fragments of placental trophoblasts that escape into the maternal circulation. At 12 weeks, the patient had a cell free DNA (cfDNA) test performed that came back abnormal, the result being high-risk. Her ultrasound that day demonstrated single intrauterine pregnancy consistent with her LMP (Figure 1A and Figure 1B). She has a history of hypertension and post-op deep vein thrombosis after an elective peroneal tendon repair. The cfDNA results, ultrasound findings demonstrating consistent growth discordance with normal interval growth otherwise, NICU management difference and placenta analysis post birth all support the diagnosis of superfetation.ĭiscussion: This case adds to the literature of human Superfetation.Ī 35-year-old gravid 1 para 0 presented to her OB/GYN at 7 weeks by known last menstrual period (LMP) for her first prenatal visit. Repeat cfDNA was normal for twin gestation and serial ultrasounds showed normal interval growth of both twins with the same discordance throughout the rest of the pregnancy. The patient's next ultrasound at 19 weeks showed a twin gestation. At 12 weeks she had a cell free DNA (cfDNA) test performed that came back abnormal. She was found to have single intrauterine pregnancy consistent with known LMP. According to previous research, the diagnosis of superfetation is suspected when there is a growth discrepancy in a multiple pregnancy.Ĭase presentation: We present a case of a 35-year-old gravid 1 para 0 who presented to her OB/GYN at 7 weeks by known last menstrual period (LMP) for her first prenatal visit. Human superfetation is extremely rare with less than 10 cases in the literature. Introduction: Superfetation is a when second ovum is fertilized after there is already presence of an embryo in the uterine cavity. ![]()
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