Prenatal Management and Postnatal Separation of Omphalopagus and Craniopagus Conjoined Twins

Abstract

Two cases of prenatally diagnosed conjoined twins are presented: a set of omphalopagus twins sharing a common liver, and a set of craniopagus with involvement limited to the skull. In both cases, prenatal diagnosis allowed accurate planning of pre- and postnatal management. Prenatal management involved serial imaging and counseling with participation of different specialists according to imaging findings. In the rare case of conjoined twins, an interdisciplinary approach is required, with feto-maternal specialists playing a pivotal role in co-ordinating teamwork and planning successive stages of management.

Three‐dimensional power Doppler in the diagnosis and surgical management of thoraco‐omphalopagus conjoined twins

“…The chance of successful postnatal separation of conjoined twins depends on the complexity of vital organ fusion 1 . For omphalopagus twins, the degree of fusion of the hepatobiliary and gastrointestinal systems is not easy to determine prenatally and can pose a significant surgical challenge 2 .…”

Prenatal Diagnosis and Management of Conjoined Fetuses

“…18 In our experience, planned postnatal surgical separation led to favorable outcomes in two cases, a case of omphalopagus and a case of craniopagus conjoined twins (Figs 9 to 12). 55 In the case of omphalopagus twins, cardiac anomalies were detected prenatally in only one of the twins, but there were no signs of shared cardiac structures, making continuation of pregnancy to a viable stage reasonable, since successful postnatal surgical separation was possible. In the case of craniopagus twins, the absence of prenatal sonographic signs of shared neural tissue showed that postnatal surgical separation might be successful as well.…”

“…In the case of craniopagus twins, the absence of prenatal sonographic signs of shared neural tissue showed that postnatal surgical separation might be successful as well. 55 Detailed prenatal counseling of parents is crucial in decisionmaking with regard to continuation of pregnancy and planning postnatal management. An interdisciplinary medical team, involving obstetricians, neonatologists, pediatric surgeons and anesthetists, should undertake counseling.…”

“…An interdisciplinary medical team, involving obstetricians, neonatologists, pediatric surgeons and anesthetists, should undertake counseling. 55 In special cases, additional consultation may be given by other specialists, even from specialized centers in other countries, depending on the area of conjunction, the involvement of other organ systems, and the presence of associated anomalies. In the case of craniopagus twins described above, parents received additional, prenatal consultation from a specialized neurosurgical center in Italy, and the twins were finally separated postnatally at the same center.…”

“…56 Obstetricians play a pivotal role in coordinating meetings between parents and members of the interdisciplinary medical team. 55 Counseling should include detailed sessions regarding the rarity and unclear etiology of this condition, as well as information about the anatomic structures involved in the area of conjunction, and associated or coincidental anomalies. Parents should be informed that there are no known inheritance patterns or contributing environmental factors.…”