We present the second case of monochorionic diamniotic (MC/DA) conjoined twins. There was minimal conjunction, which was predominantly extrafetal and confined to the periumbilical ventral region. The omphalopagus twins, attached to a single forked umbilical cord, were connected by a shared umbilical hernia containing the ileum of twin B. The only visceral conjunction, located just within the belly of twin A, was midileal with the 2 separate ileums converging toward a short segment of shared muscularis propria and of side-to-side fistulization. Gastrointestinal and musculoskeletal anomalies were present in both twins with severe amyoplasia and arthrogryposis multiplex in twin A. Possible mechanisms underlying this unusual form of MZ twinning are discussed.
Objectives To examine the incidence of fetal congenital abnormalities in cases of isolated polyhydramnious after exclusion of the common causes of polyhydramnious. Methods Retrospective analysis of all cases of polyhydramnious over a 7-year period in a busy fetal medicine unit. Cases with structural fetal abnormalities at the initial scan, abnormal glucose tolerance tests, multiple pregnancies, red cell alloimmunisation or fetal infections were excluded from further analysis. Polyhydramnious was defi ned as amniotic fl uid index >95th centile for gestational age. Results A total of 280 patients had polyhydramnious, of which, 136 met the inclusion criteria of being an isolated fi nding at the initial scan and negative for the routine tests. 133 babies were live born while there were three intrauterine deaths. There were two neonatal deaths, one as a result of prematurity. A total of 13 babies (9.5%) had congenital abnormalities. These included cases of Down's syndrome (four), cystic fi brosis (fi ve), tracheo-oesophageal fi stulae (two), microcephaly (one) and one case of neurofi bromatosis. None of these abnormalities were obvious at the fi rst ultrasonographic assessment but most were diagnosed or suspected at follow-up scans. Fetal abnormalities were not related to the severity of the polyhydramnious. Conclusion Isolated and unexplained polyhydramnious, even if mild or moderate is an independent risk factor for fetal congenital abnormalities. Karyotyping is indicated and follow-up scans are necessary even if the initial scan did not reveal obvious structural abnormalities, as these may become clearer at a later stage of the pregnancy. Postnatal examination of the baby is also recommended.
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