Antenatal diagnosis and prognosis of conjoined twins – a case report

Abstract

In this report, two conjoined twin cases that were diagnosed at the 19th and 25th week of gestational age are reported. In the first case the pregnancy was terminated because of the very poor prognosis. In the second case the decision was made to continue the pregnancy after counseling explaining the possibility of a separation procedure with good prognosis being carried out after birth. The babies were delivered at 38 weeks of gestation and the separation procedure was carried out at ten months of age without any complications. In selected cases, there is no need to abort, because of the possibility of a separation procedure after birth with good prognosis. Color Doppler ultrasound examination in an early stage of pregnancy in cases of conjoined twin can make it possible to decide which cases are candidates for a separation procedure after birth.

Vaginal Delivery of Dicephalic Parapagus Conjoined Twins: Case Report and Literature Review

“…(Spencer 1992;Itoh et al 1993;Machin 1993). The first asserts that incomplete fission of a single embryonic disc occurs 13 to 15 days after the ovum is fertilized (Quiroz et al 1989;Barth et al 1990;Hammond et al 1991;Machin 1993;Creinin 1995;Sen et al 2003;Tansel and Yazicioglu 2004). Spencer (1992) proposed a second theory: that a fertilized ovum divides completely into two embryonic discs whose unusual proximity results in secondary fusion into CTs as the embryos enlarge.…”

“…Therefore, careful ultrasound examination is recommended for all suspected twins (Fitzgerald et al 1985;Quiroz et al 1989;Barth et al 1990;Hammond et al 1991). First or second trimester detection of CTs enables obstetricians to counsel parents about potential termination, or about delivery and treatment options if pregnancy is continued (Apuzzio et al 1984;Fitzgerald et al 1985;Quiroz et al 1989;Barth et al 1990;Yang et al 1994;Mackenzie et al 2002;Sen et al 2003;Daskalakis et al 2004).…”

“…Three-dimensional ultrasound, magnetic resonance imaging, echocardiography, or computed tomography before birth, and angiography, cardiac catheterization, radionuclide scanning, cystography or urethrography, and gastrointestinal contrast studies after birth, may clarify the degree of conjoining, the potential for separation, and the ideal obstetrical and perinatal management (Quiroz et al 1989;Creinin 1995;Bianchi et al 2000;Mackenzie et al 2002;Sen et al 2003;Daskalakis et al 2004). Fetal echocardiography may miss transposition of great vessels and abnormal atria or pulmonary vascular connections, but the good buffer for imaging provided by amniotic fluid may permit better visualization than postnatal echocardiography (Barth et al 1990;Hammond et al 1991;Bianchi et al 2000;Mackenzie et al 2002).…”

“…When separation of CTs is not immediately required, surgery is usually delayed until late infancy, to permit careful preoperative evaluation and better tolerance of surgery (Creinin 1995;Bianchi et al 2000;Mackenzie et al 2002;Sen et al 2003). Intervention is sometimes needed at birth or within 24 hours (Mackenzie et al 2002).…”

Prenatal diagnosis of pygopagus tetrapus parasitic twin: case report

“…Asymmetric and parasitic conjoined twins are rarer anomalies of monochorionic monoamniotic twins, consisting of an incomplete twin attached to the fully developed body of the co-twin. Prenatal diagnosis of conjoined twins with B-mode ultrasound (US) [2,3], computed tomography (CT) [4], three-dimensional US [5,6], and magnetic resonance imaging (MRI) [6] has been reported. Parasitic conjoined twin diagnosed in utero was presented in few cases previously [7,8].…”