Antenatal Diagnosis of Parapagus Conjoined Twins: 3D Virtual and 3D Physical Models

Abstract

Conjoined twins (CTs) are a rare complication from monochorionic and monoamniotic twin pregnancies. We describe the use of 3D technologies, including 3D virtual and 3D physical models on prenatal evaluation of one parapagus CT. A 16-year-old G1P0 woman was referred for fetal magnetic resonance imaging (MRI) anatomical evaluation of a CT at 28 weeks of gestation. 3D images of the fetal surface were generated by the software during the examination for spatial comprehension of the relationship between the fetal parts. The pair of CTs died at the 32nd week of gestation, a few hours after cesarean section. 3D technologies are an important tool for parental counseling and preparation of the multidisciplinary care team for delivery and neonatal assistance and possible surgical planning for postnatal separation in CTs cases.

Applicability of the Magnetic Resonance Technique during the Gestational Period: a narrative review

“…The percentage of studies that addressed the use of magnetic resonance imaging for the evaluation of fetal brain alterations was 29.16% and the articles that presented studies specifically on the gestational consequences of Zika Virus infection corresponded to 12.50% of the total number of studies analyzed. Evaluation of the fetal skeleton [4] Ventriculomegaly [15] Changes in the development of the spine and spinal cord [18] COVID-19 [11] Preeclampsia and brain development [9] Abdominal Malformations (1) [12] Abdominal Malformations (2) [21] Oral teratoma [19] Brain Measurements / Uterine Growth Restriction [20] Hydatidiform spring [22] Brain malformations caused by Zika Virus [14] Placental changes [6] 3D Reconstructions Prototypes [23] 22 Microcephaly related to congenital Zika virus infection [24] 23 Changes in the Central Nervous System (microcephaly) related to congenital Zika virus infection [25] It was observed that 8.34% of the articles discussed placental problems, malformations and uterine pathologies, abdominal malformations, head, and neck diseases, in addition to 3D prototyping. Still, 4.16% of the studies studied non-obstetric indications for maternal MRI, hydatidiform mole, fetal skeletal structure, in addition to alterations in the development of the fetal spine and spinal cord (Table 2).…”

“…3D images of the fetal surface are generated by software during imaging tests for spatial understanding of the relationship between the fetal parts. 3D technologies are an important tool for counseling parents and preparing the multidisciplinary team for childbirth and neonatal care, as well as possible surgical planning for postnatal separation in these cases [14]. Conjoined twins (SG) represent a rare complication of monochorionic and monoamniotic twin pregnancies with an incidence ranging from 1:50,000 to 1:100,000 live births.…”

“…Recognition of anatomical features is crucial in the prenatal assessment and postnatal care of the GS, and prenatal and postnatal imaging studies are essential. In recent decades, virtual 3D techniques and 3D physical models have been described as emerging technologies for SG care and parental counseling [14].…”

“…In these cases, prenatal imaging is critical for parental counseling, individualized prenatal care, and preparation for the delivery of multidisciplinary specialty care and, postnatally, for clinical assessment of the anatomy in cases where separation is not indicated. and in case of surgical separation to provide accurate information to parents and multidisciplinary care [14].…”

“…The identification of the vascular connection is one of the key factors for the success of the surgical separation and there are many cases reporting the use of these models in the postnatal care of twins conjoined at the skull that can provide the physical characteristics in real scale of the relationship between structures. 3D technologies can be useful in the prenatal evaluation of GS and are an important tool for counseling and planning postnatal surgical separation [14].…”