Conjoined twins in dichorionic diamniotic triplet pregnancy: a report of three cases and literature review

Abstract

Background Conjoined twins are a rare and serious complication of monochorionic twins. The total incidence is 1.5 per 100,000 births, and about 50% are liveborn. Prenatal screening and diagnosis of conjoined twins is usually performed by ultrasonography. Magnetic resonance imaging can be used to assist in the diagnosis if necessary. Conjoined twins in dichorionic diamniotic triplet pregnancy are extremely rare. Case presentation We reported three cases of dichorionic diamniotic triplet pregnancy with conjoined twins. Due to the poor prognosis of conjoined twins evaluated by multidisciplinary teams, selective termination of conjoined twins was performed in three cases. In case 1, selective reduction of the conjoined twins was performed at 16 gestational weeks, and a healthy female baby weighing 3270 g was delivered at 37 weeks. In case 2, the conjoined twins were selectively terminated at 17 weeks of gestation, and a healthy female baby weighing 2760 g was delivered at 37 weeks and 4 days. In case 3, the conjoined twins were selectively terminated at 15 weeks and 2 days, and a healthy female baby weighing 2450 g was delivered at 33 weeks and 6 days. The babies of all three cases were followed up and are in good health. Conclusion(s) Surgical separation is the only treatment for conjoined twins after birth. Early determination of chorionicity and antenatal diagnosis of conjoined twins in triplet gestations are critical for individualized management options and the prognosis of normal triplets. Expecting parents should be extensively counseled by multidisciplinary teams. If there are limitations in successful separation after birth, early selective termination of the conjoined twins by intrathoracic injection of potassium chloride may be a procedure in dichorionic diamniotic triplet pregnancy to improve perinatal outcomes of the normal triplet.

A successful separation of omphalopagus twins during COVID-19 pandemic: A case report

“…Conjoined twins is an uncommon congenital case that leads to severe complications (Liu et al, 2021). The twins frequently share ventral parts of the cardiovascular and gastrointestinal systems.…”

Conjoined twins in the course of a triplet dichorionic diamniotic pregnancy

“…Cases of such a procedure in similar situations have been described in the literature. In a series of cases from 2021, three pregnancies were [9] described in which such a procedure was performed between the 15 th and the 17 th week of pregnancy. In all cases, pregnancies resulted in the birth of healthy newborns between the 34 th and the 37 th week of pregnancy.…”

“…In all cases, pregnancies resulted in the birth of healthy newborns between the 34 th and the 37 th week of pregnancy. Selective terminations were performed by injecting potassium chloride (KCl) to the CTs in 1 case and by conducting ultrasound-guided intrathoracic injection of KCl in 2 cases [9]. The literature also presents cases with a less favourable outcome, such as premature birth at 26 weeks of gestation after administering an intrathoracic injection of KCl in the first trimester of pregnancy [10].…”

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

“…The following details have been recorded for each case and are presented in Table 1 : country of origin, maternal age, gravity and parity status, chorionicity and amnionicity of triplets, whether selective termination was performed, and pregnancy and neonatal outcomes. To the best of our knowledge, 10 cases of triplet pregnancies with conjoined twins after ART have been previously reported in the literature: five cases with IVF, one with ovulation induction, and four cases with ICSI [ 14 , 21 , 32 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. Seven out of the ten cases described thoracoomphalopagus CT, 2 omphalopagus CT, and only one case of thoracopagus CT was described.…”