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Shen R, Todingbua A, Suharto HA, Imelda M, Hartono M. Parasitic pygopagus conjoined twins' incidental findings in the obstructed labor of an intrapartum dead baby that had undergone emergency C-section: rare case report in South Papua. Childs Nerv Syst 2024; 40:2631-2635. [PMID: 38695890 DOI: 10.1007/s00381-024-06440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Conjoined twins (CT), which used to be historically defined as "monstrous human" and previously so-called Siamese twins in the early eighteenth century, are one of the very rare congenital malformations with an uncertain etiology and complex yet remain inconclusively debatable regarding its pathophysiological mechanisms of fusion and fission theories. Among all types of CT, parasitic CT, especially the pygopagus sub-type, is exceedingly rarer. To the best of the authors' knowledge, no parasitic CT had been reported in Papua, and this is the first finding in South Papua. CASE REPORT Herein, a 30-year-old multigravida female with 37th-week gestation, previous twice spontaneous miscarriage, and non-adequate antenatal care history is presented with a chief complaint of painful construction and greenish fluid leakage from the vagina, with an examination that showed a cephalic presentation with a "peculiar" big mass at the upper uterus and complete cervical dilation toward second-stage inpartu. Vaginal delivery was performed with a complication of obstructed labor due to uncommon dystocia with a suspected "big mass" below the fetal buttocks and intrapartum dead. Intrapartum transabdominal ultrasound demonstrates a gross anatomically like an organ inside a fluid-filled mass with unidentified parts, leading to a suspected type of congenital malformation at the baby's sacral region. Emergency C-section was done with findings of parasitic pygopagus CT, showing an attachment of a large irregular fluid-filled mass-like incomplete twin (parasite) with palpable soft tissue and bony structure inside to the buttocks of a male autosite twin, and an additional third leg which happened to be an under-developed lower extremity with a sacrum-like structure. CONCLUSIONS An obstetrician's routine ANC and critical radiological evaluation will increase the odds of identifying CT or other congenital malformations to provide better delivery planning or further management. Increasing maternal health knowledge in society, improving medical skills and knowledge levels for health providers, and advancing supporting facilities and specialists are future strategies for managing and preventing such cases in low-middle-income countries.
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Affiliation(s)
- Robert Shen
- Atma Jaya Neuroscience and Cognitive Center (ANCC), School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
- Emergency Department, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia.
| | - Arthur Todingbua
- Department of Obstetrics and Gynecology, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia
| | - Hans Angelius Suharto
- Department of Pediatric, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia
| | - Meilina Imelda
- Department of Anesthesiology and Perioperative Medicine, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia
| | - Monika Hartono
- Emergency Department, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia
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Hînganu MV, Cucu RP, Costan VV, Lozneanu L, Tamaș C, Calistru AE, Hristian L, Hînganu D. Aging of Superficial Musculoaponeurotic System of the Face-Novel Biomarkers and Micro-CT Relevance of Facial Anti-Gravity Support. Diagnostics (Basel) 2024; 14:1126. [PMID: 38893653 PMCID: PMC11172020 DOI: 10.3390/diagnostics14111126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
The soft superficial tissues of the face are against gravity through an intricate network of ligaments and ligamentous attachments. The aim of this investigation is to delineate the relationship between the muscular, fibrous, and vascular components of the superficial musculoaponeurotic system of the face (SMAS) at the level of its periosteal fixation areas from advanced radiological and novel biomarkers' perspectives. These areas represent key points underlying skin aging and the longevity of restorative surgery results. Methods: This study was carried out on 37 surgical specimens, excised from patients admitted for surgery. On the excised specimens, we used special immunohistochemical techniques, such as markers for collagen type III, angiogenesis, vascular endothelium (I-CAM2) and muscle fibers (MYH2). We performed a micro-CT evaluation of these 37 specimens. Results: The results of this study showed different radiologic and IHC characteristics of the means of periosteal fixation of the SMAS. Evidence of morphohistological and radiological peculiarities of the retaining ligaments highlights new data for future functional studies of these structures. Our research must be continued with larger groups of subjects and through detailed methodological studies of vascular microperfusion and could represent an important new step in biotissue engineering and the customization of surgical techniques involving the sub-SMAS layers.
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Affiliation(s)
- Marius Valeriu Hînganu
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.V.H.); (L.L.); (D.H.)
| | - Ramona Paula Cucu
- Department of Oral and Maxillo-Facial Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Victor-Vlad Costan
- Department of Oral and Maxillo-Facial Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Ludmila Lozneanu
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.V.H.); (L.L.); (D.H.)
| | - Camelia Tamaș
- Department of Plastic and Reconstructive Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Anca Elena Calistru
- Department of Pedotechnics, “Ion Ionescu de la Brad” University of Life Sciences, 700490 Iasi, Romania;
| | - Liliana Hristian
- Department of Engineering and Design of Textile Products, “Gheorghe Asachi” Technical University of Iași, 700050 Iasi, Romania
| | - Delia Hînganu
- Department of Morpho-Functional Sciences I, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.V.H.); (L.L.); (D.H.)
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Wataganara T, Ruangvutilert P, Sunsaneevithayakul P, Russameecharoen K, Nawapun K, Phithakwatchara N. Three-dimensional ultrasound for prenatal assessment of conjoined twins: additional advantages? J Perinat Med 2017; 45:667-691. [PMID: 28231064 DOI: 10.1515/jpm-2016-0381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
Abstract
Conjoined twins are a rare, but serious, complication of monozygotic twins. Early prenatal diagnosis of conjoined twins is increasingly made with transvaginal ultrasound and color Doppler studies. Most prenatally diagnosed conjoined twins are terminated due to the high perinatal mortality, but advancement in pediatric surgery has allowed for successful postnatal separation in a small number of cases, and some parents may consider this option over termination of pregnancy. It is important to get a detailed prenatal ultrasound for the site and extent of fusion for an accurate categorization. Three-dimensional ultrasound (3DUS) provides images that can facilitate counselling for the parents. Additional information that impacts on diagnosis, prognostication, and perinatal management of conjoined twins could be obtained from selective use of 3DUS, particularly those with atypical fetal union. Most of the proposed additional benefits of 3DUS are based on case reports. Magnetic resonance imaging (MRI) has been increasingly used for the purpose of identifying intricate organ sharing. Because of the rarity of this condition, and the heterogeneity of fetal fusion, added benefits of either 3DUS or MRI for prenatal diagnosis and perinatal management of conjoined twins have not been demonstrated by well-conducted clinical trials. This article aims to review clinical application of various 3DUS display modes in prenatal assessment of conjoined twins, focusing on their potential additional benefits, risks and misuses. 3DUS may help detecting additional findings that are not possible with 2DUS, but, it has not been scientifically shown to improve the survival rate of the twins or reduce maternal morbidity.
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Abstract
Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis is generally poor. Accurate prenatal diagnosis by an experienced multidisciplinary team using a combination of imaging modalities allows parents to make fully informed choices. This may include termination of pregnancy, which is easier and safer at the earlier gestations at which diagnosis is now being made; continuing with the pregnancy but accepting that only palliative care is appropriate after birth; or planned intensive care and separation of the twins after birth. Delivery will invariably be by cesarean section in order to minimize the risk of peripartum harm to both mother and babies.
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Affiliation(s)
- Pat O'Brien
- Institute for Women's Health, University College London Hospitals, London NW1, UK.
| | - Mae Nugent
- Neonatal Sister Institute for Women's Health, University College London Hospitals, London, UK
| | - Asma Khalil
- St George's University Hospital, University College London Hospitals, London , UK
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Burans C, Smulian JC, Rochon ML, Lutte J, Hardin W. 3-dimensional ultrasound assisted counseling for conjoined twins. J Genet Couns 2014; 23:29-32. [PMID: 23797965 DOI: 10.1007/s10897-013-9623-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 06/11/2013] [Indexed: 12/11/2022]
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3D Assisted Prenatal Sonographic Diagnosis of Dicephalic Conjoined Twins and Subsequent Planned Vaginal Delivery. Case Rep Womens Health 2014. [DOI: 10.1016/j.crwh.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sanhal CY, Ozekinci M, Mendilcioglu I, Sakinci M, Simsek M. Prenatal diagnosis of total type 1 vertical craniopagus with 3-dimensional sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:179-181. [PMID: 24371115 DOI: 10.7863/ultra.33.1.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Diagnostic Techniques and Criteria for First-Trimester Conjoined Twin Documentation. Obstet Gynecol Surv 2013; 68:743-52. [DOI: 10.1097/ogx.0000000000000000] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen CP, Hsu CY, Su JW, Cindy Chen HE, Hwa-Ruey Hsieh A, Hwa-Jiun Hsieh A, Wang W. Conjoined twins detected in the first trimester: a review. Taiwan J Obstet Gynecol 2012; 50:424-31. [PMID: 22212312 DOI: 10.1016/j.tjog.2011.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2011] [Indexed: 12/17/2022] Open
Abstract
Conjoined twinning occurs in 1 in 100 sets of monozygotic twins, 1 in 50,000 gestations or 1 in 250,000 live births. With the advent of ultrasound technology, prenatal diagnosis of conjoined twins is possible. This article provides a comprehensive review of conjoined twins detected in the first trimester including fetal gender, maternal age, parity, types of fusion, related ultrasound abnormalities, perinatal outcome and association with assisted reproduction.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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Palacios A, Campos A, Parrell C, Díaz-Caneja C, Bermejo R. Diagnóstico prenatal de siameses toracoabdominopagos en el primer trimestre de gestación. Caso clínico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2010. [DOI: 10.1016/j.gine.2009.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gedikbaşı A, Yıldırım G, Saygılı S, Ismayilzade R, Gül A, Ceylan Y. Prenatal diagnosis of conjoined twins: four cases in a prenatal center. J Turk Ger Gynecol Assoc 2010; 11:174-7. [PMID: 24591931 DOI: 10.5152/jtgga.2010.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 02/11/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the findings in conjoined twins diagnosed prenatally. MATERIAL AND METHODS Between January 2002 and June 2009, we reviewed the database and medical records of 857 twin pregnancies, including 140 monochorionic twins. Nineteen monochorionic-monoamniotic twin pregnancies were detected, four of which were complicated by conjoined twins. RESULTS Of these 4 cases, 2 were complicated by thoracopagus and one had thoraco-omphalopagus; these three cases underwent termination at 16, 11, and 19 weeks gestation, respectively. The last case was diagnosed as a pygopagus tetrapus parasitic twin at 28 weeks gestation. The family decided to continue the pregnancy, and achieved a successful outcome with elective surgery postpartum. CONCLUSION Conjoined twins are an uncommon and complex complication of monozygotic gestations, which is associated with high perinatal mortality. The early prenatal diagnosis of conjoined twins allows improved counseling about the management options, including maintenance of pregnancy with surgery after delivery or termination of pregnancy.
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Affiliation(s)
- Ali Gedikbaşı
- Department of Obstetrics and Gynecology, Perinatology Unit, Istanbul Bakırköy Maternity and Children Diseases Hospital, Istanbul, Turkey
| | - Gökhan Yıldırım
- Department of Obstetrics and Gynecology, Perinatology Unit, Istanbul Bakırköy Maternity and Children Diseases Hospital, Istanbul, Turkey
| | - Sezin Saygılı
- Department of Obstetrics and Gynecology, Istanbul Bakırköy Maternity and Children Diseases Hospital, Istanbul, Turkey
| | - Reshad Ismayilzade
- Department of Obstetrics and Gynecology, Istanbul Bakırköy Maternity and Children Diseases Hospital, Istanbul, Turkey
| | - Ahmet Gül
- Department of Obstetrics and Gynecology, Perinatology Unit, Istanbul Bakırköy Maternity and Children Diseases Hospital, Istanbul, Turkey
| | - Yavuz Ceylan
- Department of Obstetrics and Gynecology, Perinatology Unit, Istanbul Bakırköy Maternity and Children Diseases Hospital, Istanbul, Turkey
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Ma L, Xu T, Lin J. Validation of a three-dimensional facial scanning system based on structured light techniques. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2009; 94:290-298. [PMID: 19303659 DOI: 10.1016/j.cmpb.2009.01.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 01/01/2009] [Indexed: 05/27/2023]
Abstract
The aim of this study was to validate a newly developed three-dimensional (3D) structured light scanning system in recording the facial morphology. The validation was performed in three aspects including accuracy, precision and reliability. The accuracy and precision were investigated using a plaster model with 19 marked landmarks. The accuracy was determined by comparing the coordinates from the 3D images and from the coordinates measure machine (CMM). The precision was quantified through the repeated landmarks location on 3D images. The reliability was investigated in 10 adult volunteers. Each was scanned five times in 3 weeks. The 3D images acquired at different times were compared with each other to measure the reliability. We found that the accuracy was 0.93 mm, the precision was 0.79 mm, the reliability was 0.2mm. These findings suggested that the structured light scanning system was accurate, precise and reliable to record the facial morphology for both clinic and research purposes.
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Affiliation(s)
- Lili Ma
- Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing 10081, People's Republic of China
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Abu-Rustum RS, Adra AM. Three-dimensional sonographic diagnosis of conjoined twins with fetal death in the first trimester. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1662-1663. [PMID: 18946109 DOI: 10.7863/jum.2008.27.11.1662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
PURPOSE OF REVIEW Several technological advances have greatly improved three-dimensional sonography, which have improved acquisition and display capabilities. This review describes these technical changes as well as current applications of 3D sonography in prenatal diagnosis. RECENT FINDINGS Recently published papers have emphasized the potential of getting a precise 'any plane of choice' from a three-dimensional volume, as a new way of scanning, based on the off-line analysis of a volume dataset. Surface mode has been used to demonstrate malformations and genetic diseases. The maximum rendering mode, which highlights bones, has great potential for imaging the nasal bones and the frontal bones with the metopic suture. Organ volume can be measured, but the utility of this in clinical practice remains to be determined. Three-dimensional ultrasound needs to be standardized. SUMMARY Three-dimensional ultrasonography is the most rapidly developing technique in fetal imaging. New features will permit the transition from the era of 'sonography in two-dimensional planes' to 'volume ultrasound'.
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Affiliation(s)
- Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany.
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Sherer DM, Dalloul M, Kheyman M, Zigalo A, Nader I, Sokolovski M, Abulafia O. Transvaginal color Doppler imaging diagnosis of thoracopagus conjoined twins at 7 weeks' gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1485-7. [PMID: 17060440 DOI: 10.7863/jum.2006.25.11.1485] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098 USA.
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Basgül A, Kavak ZN, Sezen D, Basgul A, Gokaslan H. Thoraco-Omphalopagus Conjoined Twins Detected at as Early as 9 Weeks of Gestation: Transvaginal Two-Dimensional Ultrasound, Color Doppler and Fetoplacental Doppler Velocity Waveform Findings. Fetal Diagn Ther 2006; 21:477-80. [PMID: 16912500 DOI: 10.1159/000093893] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Accepted: 01/21/2005] [Indexed: 11/19/2022]
Abstract
Here we report a case of conjoined twins that were diagnosed antenatally by routine two-dimensional transvaginal ultrasound examination at as early as the 9th week of gestational age. The fetuses were of the thoraco-omphalopagus type and were sharing the liver, as confirmed by color Doppler. There was a reversed flow in the single ductus venosus of the twins. Umbilical arterial and venous blood flow waveform did not show any abnormality for this gestational age. This case demonstrated the possibility of making an accurate diagnosis of conjoined twins in the first trimester by transvaginal two-dimensional ultrasound and color Doppler examination. Although conjoined twins were described at first trimester before, fetoplacental Doppler waveform findings at this gestational age have been described very rarely. This case demonstrated the possibility of making an accurate diagnosis of conjoined twins and delineating the extent of organ sharing in the first trimester, and early diagnosis can help the parents with the option for pregnancy termination. The importance of expert early vaginal sonography and color Doppler findings is emphasized.
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Affiliation(s)
- Alin Basgül
- Department of Obstetrics and Gynecology, Marmara University School of Medicine, Istanbul, Turkey.
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Suzumori N, Nakanishi T, Kaneko S, Yamamoto T, Tanemura M, Suzuki Y, Suzumori K. Three-dimensional ultrasound of dicephalus conjoined twins at 9 weeks of gestation. Prenat Diagn 2006; 25:1063-4. [PMID: 16299833 DOI: 10.1002/pd.1283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kurjak A, Pooh RK, Merce LT, Carrera JM, Salihagic-Kadic A, Andonotopo W. Structural and functional early human development assessed by three-dimensional and four-dimensional sonography. Fertil Steril 2005; 84:1285-99. [PMID: 16275217 DOI: 10.1016/j.fertnstert.2005.03.084] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 03/17/2005] [Accepted: 03/17/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To summarize the role of three-dimensional and four-dimensional ultrasound in the assessment of early human development. DESIGN Review of literature. SETTING Ultrasound research center and obstetrics and gynecology department in a tertiary care facility. RESULT(S) The introduction of high-frequency transvaginal tranducers has resulted in remarkable progress in ultrasonographic visualization of early embryos and fetuses and the development of sonoembryology. Furthermore, recent introduction of three-dimensional and four-dimensional ultrasounds combined with the transvaginal approach has produced more objective and accurate information on embryonal and early fetal development. For the first time parallel analyses of structural and functional parameters in the first 12 weeks of gestation become possible. CONCLUSION(S) The anatomy and physiology of placental and embryonic development is a field where medicine exerts its greatest impact on early pregnancy at present time, and it opens fascinating aspects of embryonic differentiation. Clinical assessment of those stages of growth rely heavily on three-dimensional and four-dimensional sonography, one of the most promising forms of noninvasive diagnostics today and embryological phenomenon, once matters for textbooks are now routinely recorded with outstanding clarity.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia.
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Vural F, Vural B. First trimester diagnosis of dicephalic parapagus conjoined twins via transvaginal ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:364-6. [PMID: 16196006 DOI: 10.1002/jcu.20141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Conjoined twins are rare, and most cases are thoracopagus. Parapagus conjoined twins (one body with two heads) are extremely rare. We report a case of dicephalic parapagus twins that was diagnosed in the first trimester at 10 weeks via transvaginal ultrasonography.
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Affiliation(s)
- Fisun Vural
- The Specialists of Obstetrics and Gynecology, Gölcük State Hospital, Obstetrics and Gynecology Clinic, Merkez mah, Turgut Sayin cad, 31, sokak No: 7/3, Kocaeli, Turkey
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Fang KH, Wu JL, Yeh GP, Chou PH, Hsu JC, Hsieh CTC. Ischiopagus conjoined twins at 9 weeks of gestation: three-dimensional ultrasound and power Doppler findings. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:309-310. [PMID: 15736206 DOI: 10.1002/uog.1852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Maymon R, Mendelovic S, Schachter M, Ron-El R, Weinraub Z, Herman A. Diagnosis of conjoined twins before 16 weeks' gestation: the 4-year experience of one medical center. Prenat Diagn 2005; 25:839-43. [PMID: 16170850 DOI: 10.1002/pd.1274] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Descriptions of the rarely occurring condition of conjoined twins are sparse. METHODS We report a case series of four conjoined twin pregnancies diagnosed up to 16 weeks of gestation. One was in a quadruplet in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) pregnancy of cryopreserved embryos and the others were spontaneous conceptions. Three were thoracopagus and had increased nuchal translucency (NT) or big nuchal cysts and one was omphalopagus. RESULTS All the three affected twin pregnancies were terminated by cervical dilatation and uterine evacuation. In another case, selective fetal reduction, shortly followed by embryo reduction to singleton was performed. Histological analysis of one case revealed dissimilar gender. No further cytogenetic or molecular studies were conducted by parental request. The pathophysiology of increased NT, subcutaneous edema or nuchal cysts in thoracopagus conjoined twins, the possible embryonic events that may lead to dizygotic conjoined twins and the clinical management of conjoined twins in sets of multiple gestation are discussed. CONCLUSIONS The current case series illustrates that there are many problems related to this rare, but intriguing, accident of nature that still need to be overcome.
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Affiliation(s)
- Ron Maymon
- Department of Obstetrics and Gynecology, Tel-Aviv University, Tel-Aviv, Israel.
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Abstract
Conjoined twins are a rare and complex complication of monozygotic twinning, which is associated with high perinatal mortality. Early prenatal diagnosis of conjoined twins allows better counselling of the parents regarding the management options, including continuation of pregnancy with post-natal surgery, termination of pregnancy or selective fetocide in case of a triplet pregnancy. With the introduction of high-resolution and transvaginal ultrasound imaging, accurate prenatal diagnosis of conjoined twins is possible early in pregnancy. We have reviewed the medical literature on the early prenatal diagnosis of suspected conjoined twins using a MEDLINE search. Although first-trimester diagnosis of conjoined twins is feasible, false-positive cases are common before 10 weeks because, earlier in gestation, fetal movements are limited and monoamniotic twins may appear conjoined. As most parents opt for immediate termination of pregnancy at confirmation of the diagnosis, there are limited data on the prenatal follow-up of conjoined twins. When the parents opt for conservative management, half of the fetuses die in utero and another 44% will die during the neonatal period. A detailed analysis of case reports where 3D imaging was used indicates that this modality does not improve on the diagnosis made by 2D ultrasound. Overall, very early prenatal diagnosis and first-trimester 3D imaging provide very little additional practical medical information compared to the 11-14 weeks' ultrasound examination.
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Affiliation(s)
- Eva Pajkrt
- Academic Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, London, UK
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Daskalakis G, Pilalis A, Tourikis I, Moulopoulos G, Karamoutzos I, Antsaklis A. First trimester diagnosis of dicephalus conjoined twins. Eur J Obstet Gynecol Reprod Biol 2004; 112:110-3. [PMID: 14687753 DOI: 10.1016/s0301-2115(03)00268-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dicephalus twinning is an extremely rare type of conjoined twins. Early prenatal diagnosis of this condition is important to provide an opportunity for pregnancy termination. We present such a case, which was diagnosed by ultrasound examination at 12 weeks of gestation. The ultrasonographic criteria are discussed together with implications for management.
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Affiliation(s)
- George Daskalakis
- First Department of Obstetrics and Gynaecology, Alexandra Maternity Hospital, University of Athens, 41 Delfon Street, 12243-Egaleo, Athens, Greece
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Chen CP, Shih JC, Shih SL, Huang JK, Huang JP, Lin YH, Wang W. Prenatal diagnosis of cephalothoracopagus janiceps disymmetros using three-dimensional power Doppler ultrasound and magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:299-304. [PMID: 12942505 DOI: 10.1002/uog.226] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report the prenatal imaging findings of a rare case of cephalothoracopagus janiceps disymmetros diagnosed at 28 weeks' gestation. Two-dimensional ultrasound and magnetic resonance imaging demonstrated janiceps conjoined female twins with a single fused cranial vault, duplicated cerebra, two faces, four eyeballs, a fused thorax, two hearts, two thoracic spines, eight limbs and polyhydramnios. Three-dimensional and power Doppler ultrasound established the definitive classification of cephalothoracopagus conjoined twins and displayed the shared circulation between the two separate hearts.
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Affiliation(s)
- C-P Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
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Sepulveda W, Munoz H, Alcalde JL. Conjoined twins in a triplet pregnancy: early prenatal diagnosis with three-dimensional ultrasound and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:199-204. [PMID: 12905520 DOI: 10.1002/uog.185] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report two cases of conjoined twins complicating a triplet pregnancy diagnosed by two-dimensional ultrasound in the first trimester and evaluated further by three-dimensional ultrasound. A review of the literature over the last 30 years revealed 11 other cases diagnosed prenatally by ultrasound. Overall, three (23%) of these 13 pregnancies were achieved by assisted reproductive techniques and 10 (77%) were diagnosed before 18 weeks. Four women opted for termination of the whole pregnancy and three were managed expectantly, with two delivering before 32 weeks. Two monochorionic pregnancies underwent selective feticide with intrauterine demise of the non-conjoined fetus in both cases. All four dichorionic pregnancies undergoing selective termination or spontaneous embryo reduction to singleton in the first trimester resulted in term delivery of the non-conjoined fetus. The rare condition of conjoined twins in a triplet pregnancy poses a significant obstetric challenge from both diagnostic and management points of view. Accurate determination of chorionicity in these cases plays a critical role in determining management and outcome.
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Affiliation(s)
- W Sepulveda
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile.
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Hanaoka U, Tanaka H, Yanagihara T, Ohno M, Hata T. Antenatal three-dimensional sonographic features of early amnion rupture sequence. J Med Ultrason (2001) 2003; 30:55-6. [DOI: 10.1007/bf02485170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2002] [Accepted: 08/04/2002] [Indexed: 10/24/2022]
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Weiss JL, Devine PC. False positive diagnosis of conjoined twins in the first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:516-518. [PMID: 12423494 DOI: 10.1046/j.1469-0705.2002.00849_1.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Horn LC, Faber R, Meiner A, Piskazeck U, Spranger J. Current awareness in prenatal diagnosis. Prenat Diagn 2001; 21:427-33. [PMID: 11360293 DOI: 10.1002/pd.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Platt LD. Three-dimensional ultrasound, 2000. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 16:295-298. [PMID: 11169302 DOI: 10.1046/j.1469-0705.2000.00318.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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