Hemodynamic Analysis of Cephalothoracopagus by the Color Doppler Method

Abstract

In a case of cephalothoracopagus, the umbilical artery (UA) was observed with color Doppler method, and the findings were compared with the hemodynamics of 46 normal fetuses. The patient was a 25-year-old primigravida who had appeared for routine prenatal visits since her 6th week of pregnancy. At a later time, the patient was examined after an interval of 4 weeks. Although an ultrasonography was also conducted, unfortunately, any findings of cephalothoracopagus were not detected. In the 25th week of gestation, we hospitalized her for marked polyhydramnios (amniotic fluid index: 280 mm), at which time an ultrasound examination revealed cephalothoracopagus. In the UA, the V_max was 30.3 cm/s (normal fetus at 25–28 weeks: 33.5 ± 3.9 cm/s). The UA hemodynamics fell below the normal range. At 26 weeks, the UA V_max was 56.5 cm/sec, a level which significantly exceeded the normal range. The patient underwent a cesarean section at 27 weeks of gestation; the indication was fetal distress. This is caused by the condition in which the fetal heart beats decreases to 90 beats per minute 3 times during a 10-min period as measured on the cardiotocograms. She delivered a 1,392-gram female with an Apgar score of 2 points (respiratory 1 point and heart rate 1 point). The infant was a cephalothoracopagus, with one head, two hearts, four upper limbs, and four lower limbs. The neonate died from circulatory failure 56 min after birth.

Prenatal Diagnosis and Management of Conjoined Fetuses

“…Effective application of serial Doppler velocimetry has been recently reported in a set of thoracopagus twins: Increasing UA maximum velocity led to decision for delivery at 27th week due to fetal distress. 39 According to previous reports, conjoined twins sharing a common heart will eventually succumb without surgical intervention within three months after delivery. 40 Prenatal cardiac evaluation of thoracopagus and omphalopagus twins allows classification of conjoined fetuses into three groups: (a) those with a single pericardium containing two normal hearts (separable conjoined twins), (b) those with fixed ventricles (inseparable conjoined twins), and (c) fetuses with conjoined atria and separate ventricles.…”

Diagnóstico pré-natal de gêmeos unidos com uso da ressonância nuclear magnética: relato de dois casos

“…No passado o diagnóstico pré-natal de gêmeos coligados não era possível, sendo hoje realizado na maioria dos casos com o uso da ultra-sonografia 10,[12][13][14][15][16][17][18] . Alguns critérios ultra-sonográficos para diagnóstico foram estabelecidos, como: ausência de membrana divisória, impossibilidade de identificação completa dos corpos fetais durante a exploração ultra-sonográ-fica, detecção de anomalias fetais e presença de mais de três vasos no cordão umbilical 19 .…”

“…Atualmente, essa tecnologia vem ganhando espaço no diagnóstico pré-natal 10,18,22,23 , principalmente devido ao desenvolvimento da técnica ultrafast que permite imagens de alta resolução em curtos intervalos de tempo 14 . Desta forma, não é mais necessária a sedação materna ou fetal para a realização do exame, podendo ser utilizada nos gêmeos unidos para se obterem informações a respeito do compartilhamento dos órgãos fetais.…”