Cephalothoracopagus, janiceps, disymmetros, monoomphalian conjoined twins undiagnosed until early second trimester

Abstract

Although first-trimester diagnosis of CTs is feasible and has been reported as early as 8 weeks's gestation, CTs may be misdiagnosed with monoamniotic twins, lymphangioma, teratoma, and/or neoplasm and may be undiagnosed until early second trimester. Three-dimensional and color Doppler ultrasound enabled precise prenatal visualization of the fusion site. Ultrafast MR imaging should be considered an adjunct to ultrasound for antenatal characterization of structural anomalies and for planning surgical separation in selected cases. Echocardiography is mandatory in all cases of CTs as congenital heart defects are seen in 20-30% and polyhydramnios in 50-75%. Neural tube and midline fusion defects, diaphragmatic hernia, and imperforate anus are the frequently associated abnormalities. Prognosis among survivors is usually poor (44% die in the neonatal period) and is dependent upon the type of conjunction, degree of involvement of the shared organs, and presence or absence of associated anomalies, with the worst prognosis in case of twins sharing liver and heart.

Conjoined Twins Complicating a Dichorionic Triplet Pregnancy after Intracytoplasmic Sperm Injection: A Case Report and Review of the Literature

“…Prognosis among survivors depends on the type and degree of conjunction and on the presence or absence of associated congenital anomalies. Interestingly the worst prognosis affects CT with sharing liver and/or heart [ 10 , 11 ].…”

“…In contrast, Pajkrt and Jauniaux support that 3D imaging does not improve on the diagnosis achieved using 2D ultrasound, as the additional practical medical information is really low, compared to the 11–14 weeks ultrasound examination [ 9 ]. MRI should be considered as an alternative for prenatal characterization of structural anomalies, since there is no evidence that MRI is associated with any risk to the developing foetus [ 10 , 16 ]. CT should be referred to specialized centres for detailed foetal anomaly and echocardiographic assessment to evaluate prognosis [ 17 ].…”

Prenatal Diagnosis and Postnatal Findings of Cephalothoracopagus Janiceps Disymmetros: A Case Report

“…The diagnosis usually is realized by 2D ultrasound, as our case [7–9] in the end of second trimester. The 2D ultrasound is the main imaging method for diagnosis of fetal malformations, because it is cheap, without risk to women pregnant, and it is available in several secondary services.…”

Prenatal Diagnosis of Cephalothoracopagus Janiceps

“…Moreover, only 5 cases were prenatally described with 3-dimensional (3D) sonography. 2,[5][6][7] The objective of this report was to describe prenatal diagnosis and delineate the fused structures using both 2-dimensional (2D) and 3D sonography.A 21-year-old pregnant woman, para 2001, attended the first antenatal care clinic of a primary hospital at 26 weeks' gestation. Initial sonography at the first visit revealed fetal abnormalities suggestive of conjoined twins with a single placenta and polyhydramnios.…”

“…Moreover, only 5 cases were prenatally described with 3-dimensional (3D) sonography. 2,[5][6][7] The objective of this report was to describe prenatal diagnosis and delineate the fused structures using both 2-dimensional (2D) and 3D sonography.…”