Conjoined twins and abdominal pregnancy

Phenotypically Discordant Anomalies in Conjoined Twins: Quirks of Nature Governed by Molecular Pathways?

A multitude of additional anomalies can be observed in virtually all types of symmetrical conjoined twins. These concomitant defects can be divided into different dysmorphological patterns. Some of these patterns reveal their etiological origin through their topographical location. The so-called shared anomalies are traceable to embryological adjustments and directly linked to the conjoined-twinning mechanism itself, inherently located within the boundaries of the coalescence area. In contrast, discordant patterns are anomalies present in only one of the twin members, intrinsically distant from the area of union. These dysmorphological entities are much more difficult to place in a developmental perspective, as it is presumed that conjoined twins share identical intra-uterine environments and intra-embryonic molecular and genetic footprints. However, their existence testifies that certain developmental fields and their respective developmental pathways take different routes in members of conjoined twins. This observation remains a poorly understood phenomenon. This article describes 69 cases of external discordant patterns within different types of otherwise symmetrical mono-umbilical conjoined twins and places them in a developmental perspective and a molecular framework. Gaining insights into the phenotypes and underlying (biochemical) mechanisms could potentially pave the way and generate novel etiological visions in the formation of conjoined twins itself.

Primary twin omental pregnancy: report of a rare case and literature review

OBJECTIVE

To report a very rare case of a primary twin omental pregnancy.

DESIGN

Case report.

SETTING

The emergency department of a university teaching hospital.

PATIENT(S)

A 36-year-old woman.

INTERVENTION(S)

Partial omentectomy by laparotomy.

MAIN OUTCOME MEASURE(S)

Laparotomy successfully performed in the case of a twin omental pregnancy.

RESULT(S)

A 36-year-old woman presented with intense abdominal pain of 3 days' duration, hypotensive, with distended abdomen and signs of peritoneal irritation, and no transvaginal bleeding or evidence of topic pregnancy. Laparotomy showed normal internal genital organs and the presence of a large hemoperitoneum with a twin omental pregnancy. Partial omentectomy was performed. The patient progressed well postoperatively, and subsequent beta-hCG titer was negative.

CONCLUSION(S)

Primary omental twin pregnancy is extremely rare, and when associated with acute abdomen and large hemoperitoneum, laparotomy is required for treatment.

Malformations and deformations in abdominal pregnancy

Abdominal gestation is a relatively uncommon complication of pregnancy. Previous reports describe a high incidence of fetal deformations and mortality as well as maternal mortality. A case of twin abdominal gestation is presented and the literature concerning abdominal pregnancy since 1809 is reviewed. The survival rate of liveborn infants of 30 or more weeks gestation was 63%. The maternal mortality rate since 1809 was 18.2%, but this has decreased to 4.5% during the last 20 years. The combined rate of malformations and deformations in the infants was 21.4%. The most common deformations observed were facial and/or cranial asymmetry and various joint abnormalities. Among the most common malformations were limb deficiency and central nervous system malformations. Proposed mechanisms of compression and vascular disruption are discussed.