Dicephalic twins account for around 11% of all conjoined twins. Dicephalic parapagus is an uncommon form of lateral partial twinning characterized by two heads on one trunk. A 25-year-old primigravida was referred to our clinic with a conjoined twin diagnosis, which was made for the first time at 29 weeks of gestation. The fetus had two heads, two separate necks, two vertebrae, a fused heart with two apexes, four ventricles, three atriums, two gastrics, a fused liver, four kidneys (one of which had hydronephrosis and the other concurrent hydroureteric), two bladders, one male gender, two arms, and two legs, according to an ultrasound. A second case is a pair of conjoined twins that were discovered at 20 weeks of gestation and are 29 years old. The results of an ultrasonographic test showed that the fetus has two vertebrae, one heart, one hepar, one umbilical insertion, and one foot with a congenitally equinovarous talus and a rocker bottom. Both pregnancies ended due to family requests for termination and after a conjoined twin committee meeting in our hospital was approved and the unseparable conjoined twin fetus diagnosis was made. The size of two heads necessitated a Caesarean operation.

Context: Owing to its extensive inflammation, COVID-19 infection may have a specific response in the anti-inflammatory milieu of pregnancy. Aims: To analyze the lacking evidence of systemic inflammatory and anti-inflammatory cytokine responses of pregnant women with COVID-19 infection compared to normal pregnancies. Methods: This case-control study was performed on third-trimester symptomatic COVID-19 pregnant women compared with normal pregnancies without other significant inflammation risks. A between-group analysis was conducted to assess the inflammatory, and anti-inflammatory cytokines and chemokines. Through a comparison and correlation analysis, we detected differences between cytokines in the COVID-19 group based on the severity of the infection. Results: Pregnant women with COVID-19 had higher procalcitonin levels (p<0.01), IL-6 (p=0.05), TNF-, IFN-γ/IL-4 ratio (p<0.01), and lower IL-4 (p<0.05), implying a higher proinflammatory cytokine imbalance in this group compared with normal pregnancies. White blood cells (p<0.05; r=0.345), and IL-17 (p<0.05; r=0.328) had weak positive correlation, while CRP (p<0.01; r=0.484), and IL-6 (p<0.01; r=0.41), had moderate positive correlation with COVID-19 severity during pregnancy. Conclusions: COVID-19 infections provide a unique non-dominance of the anti-inflammatory response in pregnant women, as indicated by a lower response of Th2, which may counteract the Th1 response. These cytokine dysregulations may disturb the viral defense mechanism, leading to a proinflammatory condition as shown by higher TNF-, IL-6, and IFN-/IL-4 ratios. Some inflammatory markers have a positive correlation with COVID-19 severity (WBC, CRP, IL-6, and IL-17), suggesting their potential roles as severity markers during pregnancy.