Iris Publishers_World Journal of Gynecology & Womens Health

Association of Cytomegalo-Virus and Rubella Virus Infections in Pregnant Women with bad Obstetric History

Background: Bad obstetric history (BOH) comprises of previous adverse fetal consequences in terms of two or more successive spontaneous abortions, early neonatal deaths, stillbirths, intrauterine fetal deaths, intrauterine growth retardations and congenital anomalies. The infections which are caused by Rubella virus and CMV during pregnancy are often associated with adverse fetus outcomes and reproductive failures. In the Yemen context, the exact seroprevalence of these infections is not known due to unavailability of baseline data.
Objective:The main aim of this study was to determine the correlation of the main viral TORCH infections (Rubella and CMV) during pregnancy among Yemeni females with BOH.
Methods:Two hundred- sixty-eight serum samples were collected from participants having BOH, attending Department of Obstetrics and Gynecology, Al-Sabian University hospital, Sana’a city during the period of September 2017 to September 2018. IgM antibodies for Rubella virus and CMV were detected by micro-capture ELISA tests.
Results:The common causes of BOH were abortion (52.6%), intrauterine fetal death (22%) followed by intrauterine growth retardation (10.4%). Fourteen (5.2%) of pregnant women were positive for CMV IgM antibodies, 10 (3.7%) for Rubella IgM antibodies and 4 (1.5%) for CMVRubella virus in combination; indicating recent infections. There was significant association between the positive results of anti-CMV IgM -anti- Rubella IgM with age group ≥ 36 years (OR=31,6.2 respectively). Also, there was a significant association between the positive results of anti-CMV IgM with congenital deformation (OR=10.2, p<0.001).
Conclusion: IgM antibody positivity was high for Rubella and CMV and there is a strong association of these agents with BOH. Thus, screening and early diagnosis for these pathogens in women can help in proper management of these cases to prevent fetus loss.
Keywords: TORCH; Bad obstetric history (BOH); CMV; Rubella virus; IgM; Sana’a; Yemen

Introduction

Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortions, history of intrauterine fetal death, intrauterine growth retardation, stillbirth, early neonatal death, and/or congenital anomalies [1]. The causes of BOH may be genetic, hormonal, abnormal maternal immune response, and maternal infections [2].

The prenatal and perinatal infections, falling under the designation of TORCH complex [3] (also known as STORCH, TORCHES, or the TORCH infections), are a medical acronym for a set of perinatal infections [4], i.e., infections that are passed from a pregnant woman to her fetus. The TORCH infections can lead to severe fetal anomalies or even fetal loss. They are a group of viral, bacterial, and protozoan infections that gain access to the fetal bloodstream trans placentally via the chorionic villi. Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-to-fetal transfusion [5]. Primary infections caused by TORCH-Toxoplasma gondii, Rubella virus, CMV and herpes simplex virus (HSV)-are the major causes of BOH [6]. These infections usually occur before the woman realizes that she is pregnant or seeks medical attention. The primary infection is likely to have a more important effect on fetus than recurrent infection and may cause congenital anomalies, spontaneous abortion, intrauterine fetal death, intrauterine growth retardation, prematurity, stillbirth, and live born infants with the evidence of disease [7]. Most of the TORCH infections cause mild maternal morbidity but have serious fetal consequences [8]. The ability of the fetus to resist infectious organisms is limited and the fetal immune system is unable to prevent the dissemination of infectious organisms to various tissues [9]. An attempt is being made in this work to find out the correlation of the main viral TORCH infections namely Rubella and Cytomegalovirus during pregnancy among Yemeni females with BOH in Sana’a city, Yemen.

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ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research | The ISSN Portal

ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research | The ISSN Portal: ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research

ISSN 2641-6336 (Online) | Annals of biostatistics & biometric applications | The ISSN Portal

ISSN 2641-6336 (Online) | Annals of biostatistics & biometric applications | The ISSN Portal: ISSN 2641-6336 (Online) | Annals of biostatistics & biometric applications

ISSN 2687-8089 (Online) | Advances in oceanography & marine biology | The ISSN Portal

ISSN 2687-8089 (Online) | Advances in oceanography & marine biology | The ISSN Portal: ISSN 2687-8089 (Online) | Advances in oceanography & marine biology

ISSN 2687-8402 (Online) | Open access journal of archaeology & anthropology | The ISSN Portal

ISSN 2687-8402 (Online) | Open access journal of archaeology & anthropology | The ISSN Portal: ISSN 2687-8402 (Online) | Open access journal of archaeology & anthropology

ISSN 2687-8410 (Online) | Archives of clinical case studies | The ISSN Portal

ISSN 2687-8410 (Online) | Archives of clinical case studies | The ISSN Portal: ISSN 2687-8410 (Online) | Archives of clinical case studies

Iris Publishers_World Journal of Gynecology & Womens Health

Steroids Administration at Term in Egypt: Does it become a Routine Practice?

Abstract

Background: Antenatal steroids become a routine daily practice before elective Cesarean deliveries in Egypt. These drugs were recommended only from 24 weeks to 34 weeks of gestation to minimize respiratory morbidities in newborn. Steroids are not without side effects or complications for both the baby and the mother.
Objective: To evaluate the evidence regarding the use of antenatal steroids at term prior to scheduled cesarean delivery. Materials and Methods: Reviewing published data in recent ten years since January 2009 till 31, December 2017.
Results: Antenatal steroids were recommended only from 24 weeks to 34 weeks with extension up to 37 weeks of gestation not later to minimize respiratory morbidities in newborn.
Conclusion: Steroids are not without side effects or complications for both the baby and the mother. These drugs should be limited to high risk patients with imminent preterm birth and discouraged before term deliveries till evidence approve its long-term safety.
Keywords: Antenatal steroids; Scheduled; Cesarean delivery; Neonatal; Maternal outcomes

Introduction

Antenatal steroids were mainly given in high risk situations with eminent preterm birth as multiple gestations, cervical incompetence, polyhydramions and patients with history of previous preterm birth. Corticosteroids are of great benefit for normal development and enhancement of lung maturity. Evidence supports the use of steroids in those patients with strong limitation to single course and discouraging multiple weekly courses. Many authors advocate the use of steroids at term before scheduled cesarean delivery, but other institutions disagree with the results and conclusions of these studies [1,2].

Discussion

Nowadays, many studies emerged with evidence supporting the use of such drugs before term cesarean delivery ≤ 39 weeks. This practice became a routine daily practice even in gestations beyond 39 weeks. Many researchers advised the use of steroids before term elective cesarean section to reduce respiratory and composite morbidities [3-5].
On the other hand, many studies found that exposure of the fetus at term to corticosteroids either by betamethasone or dexamethasone can profoundly affect the development of the neuroendocrine system at term than at any other time in pregnancy duration. These drugs had life-long effects on endocrine system, emotions, affection and cognitive functions. These side effects of corticosteroids are still under continuous investigation and evidence till now didn’t reach to a final conclusion regarding this issue [6,7].
Do exogenous synthetic steroids affect endogenous corticosteroids surge near term? Do they affect the mechanism and initiation of parturition mechanism? Do they affect brain and other organs if they were given prior to delivery? Evidence still had no clear answers to these questions. Debates are still present whether to revise the use of steroids before term cesarean or not [6,7]. Nabhan A et al [8], in their study found that prophylactic antenatal corticosteroid for elective cesarean delivery between 34 and 37 weeks is not effective in improving neonatal outcomes [8]. De Vivo et al, found that wound complications were more in patients who received antenatal steroids before Cesarean section [9].

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ISSN 2641-2020 (Online) | Archives of pharmacy & pharmacology research | The ISSN Portal

ISSN 2641-2020 (Online) | Archives of pharmacy & pharmacology research | The ISSN Portal: ISSN 2641-2020 (Online) | Archives of pharmacy & pharmacology research

ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research | The ISSN Portal

ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research | The ISSN Portal: ISSN 2641-6360 (Online) | World journal of ophthalmology & vision research

Iris Publishers_World Journal of Gynecology & Womens Health

Black Pregnant.2019

In 1986, the CDC established the pregnancy mortality surveillance system to evaluate clinical issues surrounding maternal death. At its inception the number of maternal deaths was noted to be 7.2/100,000; in 2019, three decades later, the rate has almost tripled-with Black women disproportionately affected, no matter the socioeconomic status. The cause of this disparity remains unclear. Extant studies have proposed myriad factors, inclusive of prenatal infections, lack of prenatal care and medical co-morbidities, during pregnancy as critical. While these internal factors are important, what impact do external influences, such as racism and implicit bias factor into the dismal perinatal outcomes that are prevalent in 2019? This editorial will explore internal and external forces impacting perinatal health for women of color.

Policy makers have known for years that racial and ethnic differences in health outcomes exist and multiple agencies like the Federal government have prioritized venues- like Health People 2010- the goal of which was the elimination of racial disparities in health outcomes. The final review of Healthy People 2010 was, while it was an ambitious endeavor, there was a significant lack of progress in reducing health disparities. What it did achieve was the development of more informative models and approaches to measuring disparities which serves as an information foundation for Healthy People 2020.

There are two words that need to be highlighted- difference and disparity- and the question becomes when does a difference become a disparity? There is little consensus on what constitutes a disparity or when a difference between two groups should be given the more charged term disparity. For some, disparity implies an inequity or an injustice, rather than a simple inequality. Determining when a difference becomes a disparity is not measured directly, but rather as a residual or a distinction between two groups, often after other factors might contribute to that difference have been statistically controlled for. Difference vs disparity is quite important when discussing the reproductive disadvantages seen among African American women in this country. Does a difference exist which compounds the disparities noted?

Despite improvements in obstetrical and neonatal care, Black infants and mothers still experience excess mortality. The mortality rate for Black infants is 2.5 x higher than for White infants. Black women have 4x higher pregnancy related mortality and 70% higher hospitalization rates for pregnancy related complications than do White women. Extreme preterm birth, fetal growth restriction and sepsis predominantly account for excess Black neonatal mortality; conversely vascular, hypertensive and infection related complications primarily account for disparity in maternal mortality and morbidity.

There are certain experiences embedded within the social context of African American women’s lives; exposure of lifelong stress, and genetic variables- but when stratified across a socioeconomic continuum-the same poor prenatal outcomes still persist. So, the question becomes are there certain pathophysiologic differences at hand accounting for outcomes?


Genitourinary, and to a lesser extent, non-genitourinary tract infections are implicated in preterm birth. Intrauterine infection seems to be the common denominator to racial disparities regarding preterm birth. Although the exact mechanism hasn’t been fully elucidated, intrauterine infection likely results from ascending lower genital tract infections preceding or shortly following conception. Most types of genitourinary infections, including sexually transmitted diseases like gonorrhea, trichomonas, and chlamydia and non-sexually transmitted infections such as Group B strep, UTI and bacterial vaginosis occur more frequently among Black women. Numerous studies have correlated vaginal infection with BV to the high incidence of preterm birth. There is a compelling body of evidence that racial differences exist in the vaginal flora or the vaginal microbiome of women. A healthy vagina has an abundance of lactobacillus species that work to ward off infectious entities by their production of hydrogen peroxide, lactic acid and bacteriocins- in addition they maintain an acidic vaginal pH. Research in this arena has noted that Black women affected by preterm labor show a shift, or an imbalance, of these helpful bacteria to a more diverse polymicrobial community. This variation allows for an overgrowth of pathogenic bacteria and a resultant change to a more alkaline pH-increasing the risk of ascending intrauterine infection resulting in preterm labor and endometritis in the postpartum period.

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Iris Publishers_World Journal of Gynecology & Womens Health

Ureteral Stenosis after Uterine Suspension Using TVM (Transvaginal Mesh)

Introduction

We report a rare case of ureteral stenosis after sacrospinous suspension. A 64-year-old post-menopausal female, G2P2, complained of a heavy sensation and the feeling of sitting on a ball, especially in the afternoon. Tracing back her previous surgical history, she had undergone a cesarean section and subtotal hysterectomy due to myoma with severe adhesion. A pelvic examination revealed total prolapse of the vaginal cervix with stage III cystocele. A urodynamic study revealed bladder outlet obstruction, and a pad test was 13g after restoring the vaginal cervix. Therefore, after explaining the risks and complications of surgery, Pelvic organ prolapse (POP) surgery including sacrospinous suspension (Upholds), mid-urethral sling surgery (Solyx) and anterior compartment repair was performed. Ten days after surgery, she returned to our hospital due to left costovertebral angle pain plus knocking tenderness. CT showed hydronephrosis without urolithiasis, and antegrade pyelography also showed ureteral stenosis in the lower third (Figure 1). After several attempts at stent insertion had failed, a urologist suggested re-implanting the ureter. The postoperative course was uneventful. Intravenous pyelography was performed 4 months after this surgery, and showed a patent left ureter.

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Iris Publishers_World Journal of Gynecology & Womens Health

An Established Technology Gets a New Application: Reimplantation of Autologous Ovarian Tissue to Treat Menopausal Symptoms

Introduction

In 1954 and 1956, Deanesly [1] and Green, et al. [2] were one of the first to experiment with the freezing and thawing of animal ovarian tissue. In the first half of the 20th century, the art of tissue cryopreservation was at its infancy with glycerol being the only cryoprotectant available [3]. Glycerol is a poor cryoprotectant and, therefore, early research showed very limited success [4]. Additional cryoprotectants became available during the 1990s leading to successful ovarian tissue cryopreservation, transplantation, and resumption of fertility studies in animals and humans [3,5,6].
In 1983, Trounson and Mohr [7] reported what appeared to be the first ever pregnancy in a human following preservation and transfer of an [8] cell embryo. This was followed by the report of the first human live birth after ovarian cryopreservation and transfer with more cases to follow [8,9]. Sonmezer and Oktay [10] performed a metanalysis, which included 21 studies on oocyte cryopreservation. They found that the mean oocyte survival rate after thaw, mean fertilization rate, and mean pregnancy rate per cryopreserved/thawed oocyte was 47%, 52.5%, and 1.52%, respectively.10 In a recent interview, Oktay, et al. [11] cited the first report of resumption of ovarian endocrine function following orthotopic transplantation of frozen banked ovarian tissue.

Summary

The preservation and autologous transplantation of endocrine glandular tissue is not limited to the ovaries. In 1977, Wells, et al. [12] introduced reimplantation of autologous cryopreserved parathyroid tissue as a treatment modality of hypoparathyroidism. Wagner, et al. [13] simplified the methods of parathyroid gland cryopreservation and storage. For cryopreservation, the parathyroid tissues were cut into cubes of 1 mm in length. The time between parathyroidectomy and replantation of cryopreserved tissue was 5 months on average (range, 0.5 to 15 months). Follow up examinations in 25 patients were performed 6 months to 120 months (median: 40 months) postoperatively. In all patients, the autografts functioned well and most of the patients did not require any additional medication [13].
Despite technical difficulties with cryopreservation at that time, pioneering research in parathyroid autotransplantation was performed in the 70s by Alveryd, et al. [14] and Wells, et al. [15,16], Alveryd, et al. [14] described six patients with primary parathyroid hyperplasia who had parathyroid autografts. In 1976, Wells, et al.15 reported an additional four patients with primary parathyroid hyperplasia who were treated by total parathyroidectomy and auto transplantation of parathyroid tissue inserted into the forearm muscle. All of these patients remained norm calcemic at 9 and 13 months, respectively. Good graft function was documented further by detection of a higher concentration of parathyroid hormone in the patients’ blood. Hormonal activity of auto transplants, if excessive, can be adjusted by removing some transplanted tissue [15]. Additional implantation can be carried out if the amount of tissue initially implanted had been insufficient or if the transplanted parathyroid tissue failed to survive. In the rat model, parathyroid isografts functioned normally after cryopreservation for up to 9-12 months [16]. Wells, et al. [15] grafted autologous parathyroid tissue, frozen for six weeks, into a patient who had had a total parathyroidectomy for renal osteodystrophy. The graft was still functioning 18 months after the procedure.
Research on oocyte and ovarian tissue cryopreservation has gained momentum in recent years [17]. Oktay, et al. [18] reported their experience with auto transplantation of ovarian tissue in cancer patients to alleviate premature menopause and preserve fertility.
Inspired by the success in parathyroid tissue auto transplantation and recent advances in ovarian tissue cryopreservation technology, we propose to apply this technique to treat menopausal symptoms.19 We established an ovarian tissue cryopreservation bank in 2000 in collaboration with Professor E. Zharov (Russian Federation) with the goal to collect and preserve ovarian tissue retrieved with the patient’s consent during indicated obstetrical or gynecological procedures (cesarean section-15, minilaparotomies and tubal ligation – 12, gynecological surgeries for benign conditions – 22). Since our computer-assisted search failed to find an ovarian tissue bank with similar goals, we used the experience of the ovarian transplantation program in Denmark for the purpose of preserving ovarian tissue to combat infertility. The ovarian transplantation program started in Denmark in 2000 (800 women have had their ovarian tissue frozen) [19]. For this study, the researchers studied the outcomes of women who had received transplantation between 2003 and June 2014. The functional life span of the grafts varied between one and ten years; grafted tissue robustly restored ovarian function.
In 2000, we initiated a research protocol at Nassau University Medical Center (Petrikovsky BM, Ansari AH, Beers PG, et al. which stated as follows:
After obtaining approval from the Institutional Review Board, patients, ages 40 and under, will be included in this study. Normal ovarian function in these cases is to be established prior to ovarian sampling, using such methods as; hormonal assay, pelvic ultrasonography and endometrial sampling. Opportunistic ovarian biopsy will be performed by means of laparoscopy or laparotomy. Ovarian cortex will then be separated from its stroma and divided into several pieces. Each piece will be placed in a special cryovial container and filled with a special cryoprotectant solution (dimethyl sulfoxide, human serum albumin factor V). The cryovials are then transferred to a special aluminum case and lowered into a liquid nitrogen tank where it is stored until such time that it is used for autologous transplantation. To assess potential structural alterations, it is the further aim of this study to examine a portion of the ovarian tissue by means of TEM, prior to and after freeze thawing. Whenever, clinically indicated, the specimen will be thawed and reimplanted, subcutaneously, in a cosmetically acceptable body site. The function of the transplanted ovarian tissue will be assessed clinically by re-evaluation of symptomatology, as well as such techniques as bone density analysis, ultrasonography, and hormonal assay.”
None of the patients experienced complications directly related to opportunistic ovarian sampling. Now, 20 years later, histological assessment of preserved ovarian strips (15 samples) demonstrated ovarian tissue adequate for reimplantation, 6 samples contained visible icicles and were judged unfit for transplantation.

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ISSN 2641-6379 (Online) | World journal of agriculture and soil science | The ISSN Portal

ISSN 2641-6379 (Online) | World journal of agriculture and soil science | The ISSN Portal: ISSN 2641-6379 (Online) | World journal of agriculture and soil science

Iris Publishers_World Journal of Gynecology & Womens Health

Assessment of Bacterial Contamination at the Time of Embryo Transfer, and its Impression on the in-vitro Fertilization / Pregnancy Outcome, in Sana’a City, Yemen

Abstract

Background: In spite of advances in the field of assisted reproductive techniques including in-vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI), the pregnancy rate remained low. One of the major events in fertility is implantation process. One of the most important negative factors affecting implantation and pregnancy outcome is introduction of normal flora or potential pathogens of vagina or cervical region into uterus during embryo transfer.
Objectives: This study was designed to determine the most contaminants bacteria and examine the effect of bacterial contamination on in-vitro fertilization treatment outcomes.
Methods: A prospective clinical trial was carried out during a period of 12 months, starting in October 2016 and ending in September 2017. 162 patients aged 23–38 years, mean 32.4±5.7, undergoing IVF treatment were selected for this study. Catheter tip samples were collected poster embryo transfer, cut off and cultured to identify any bacteria present by bacterial standard methods.
Results: The pregnancy rate of the 162 studied women was 54.32% (positive B-hcg) and 45.68% had pregnancy failure (negative B-hcg). The highest positive pregnancy rate occurred in age group 26-29 years (63%). The most contaminants bacteria were Staphylococcus coagulase negative (21.4%), Non-hemolytic streptococci (17.9%), Pseudomonas aeruginosa (17.9%) and E. coli (14.3%). The pregnancy rates did not differ significantly between the positive and negative bacterial growth, but significant decreased pregnancy rate was observed in patients who are positive to Pseudomonas aeruginosa, and E. coli.
Conclusion: Bacterial colonization of the ET catheter tip particularly with Pseudomonas aeruginosa and E. coli is associated with a reduction in the clinical pregnancy rate. Usefulness of routine cervical swab; microscopy, culture, and sensitivity at preparation of patients for IVF–ET treatment is suggested.

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We invite authors from around the world and from all fields in science to publish their work with us to reach a larger, more relevant audience. Our submissions go through rigorous peer reviews and quality checks.

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Research articles from major scientific fields are also welcome. These papers are expected to include findings, present evidence and explain the methodology used to achieve the final conclusion.

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Iris Publishers_World Journal of Gynecology & Womens Health

Special Clinical Characteristics of Struma Ovarii- Two Unique Cases Report

Introduction: Struma ovarii is a rare type of ovarian cystic teratoma with composed of predominantly thyroid tissue. It occurs between 30-50 years of age, usually in unilateral ovary. Struma ovarii rarely occurs before puberty and is growing slowly. Hereby we reported 2 cases in which one case with combined cystic teratoma in one side and Struma ovarii in contralateral side of ovary, the second case with Struma ovarii occurs at age of 16 then growing tremendously with in only 8 years.
Methods: A retrospective study of the data bases of community hospitals in Taipei city during 2014 -2016 were included. Two cases with a histological diagnosis of Struma ovarii who had undergone surgery were identified.
Patients
Case 1: A 29-year-old female patient presented with recently irregular vaginal bleeding, abdominal distention and low abdominal palpable mass. Her past history revealed right ovarian cystic teratoma underwent laparoscopic removal of tumor at age of 16. CT scan revealed the contralateral ovarian calcified tumor (10cm x 7.5cm) with heterogenous mass with solid and cystic components. Post-operative finding was left ovarian cyst with smooth surface and gelatinous material content.
Case 2: A 24-year-old single patient presented with amenorrhea and abdominal distention. She had history of right ovarian simple cyst (4.2cm x 3.2cm) at age of 16. She came after 8 years; the physical examination found the ovarian tumor growing to a tremendous size. CT scan showed a homogenous cystic tumor 25.8cm x 25.7cm x 16cm with a few heterogenous enhanced nodules. Post-operative finding of big left ovarian cystic tumor, glistening surface with gelatinous material, few septations was observed.

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Iris Publishers_World Journal of Gynecology & Womens Health

Carrier Rate of Citrullinemia, Type I in Individual Ethnic Groups Using an Expanded Carrier Test

Purpose: To identify population-specific carrier frequencies for Citrullinemia Type 1. Better knowledge of population specific carrier frequencies improves carrier testing and genetic counseling; however, prior reports have not captured data in specific ethnic groups. Identifying a fetus at risk for CTLN1 could allow prenatal planning by arranging for appropriate post-partum care to mitigate or prevent long lasting neurological damage with prompt use of metabolic therapy.
Methods: Retrospective review of 11,132 individuals who underwent expanded carrier testing utilizing a genotyping panel. The CTLN1 variants included were the common 1168G>A variant, and the rarer 421-2A>G/910C>T variant. Adjusting for the genotyping panel’s detection rate we calculated the carrier frequency for specific ethnic groups.
Results: Pan-ethnic carrier frequency of 1:383 (10*2.9/11,132), corresponding to a population prevalence of 1: 575,000. Adjusted carrier rates are: 1/124 in the Ashkenazi Jewish group; 1/392 in the Hispanic group;1/422 in the Caucasian/White group.
Conclusion: As expanded carrier testing utilization increases, it is important to continue to reassess carrier and disease frequencies of rare conditions with large ethnically diverse cohorts. This is the first report, to our knowledge, to document CTLN1 carrier rate in individual ethnic groups. This knowledge can guide preconception and prenatal counseling enabling patients and providers to identify resources and neonatal management options.
Precis: CTLN1 carrier rates vary amongst different ethnic groups

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Iris Publishers_World Journal of Gynecology & Womens Health

Dichorionic Twin Pregnancy Discordant for Fetal Anencephaly: A Case Report

Background: Anencephaly is a lethal diagnosis. In twin pregnancies discordant for anencephaly, there are risks of development of polyhydramnios, severe preterm delivery and death of an encephalic fetus.
Case presentation: A 30-year-old G 111 Para 11 both were vaginal delivery presented at Ian Donald ultrasound department for first time scan at 27-week gestational age. Ultrasound showed a live dichorionic, diamniotic intrauterine twin pregnancy. The Gestational age was 27 weeks and 5 days. A cranium of twin A was described. Polyhydramnios was noted for twin B at 29+5 weeks. After adequate obstetric, genetic counseling and given all the information about the risks involving this pregnancy, the parents opted for conservative management without any intervention.
Conclusion: The early diagnosis of anencephaly before 16 weeks’ gestational age in the twin decrease morbidity and mortality to the unaffected normal twin by providing the option of selective fetal reduction at an optimal gestational age.

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