Conjoined twin is a rare complication seen in 1% of monochorionic twins and associated with severe morbidity and mortality. It occurs due to a division event at the primitive streak stage of the human embryonic development at about 13-14 days after fertilisation, in monochorionic monoamniotic gestations. Early prenatal diagnosis of conjoined twin plays a very crucial role in the management and allows appropriate and timely counselling of couple regarding the different modes of management like early termination of pregnancy or continuation of pregnancy with post-natal surgery. Late diagnoses present with difficult options for parents and obstetrician too. Ultrasound plays a very crucial role in diagnosis of conjoined twin. We are reporting a case of 27 years old primigravida referred to our institute at 13 weeks of gestation with ultra-sonographic diagnosis of dicephalus parapagus conjoined twin and further confirmed after termination of pregnancy.
When implantation of the early embryo occurs at the scar of previous cesarean, it is called cesarean scar pregnancy. Though in uterus, it behaves like an ectopic pregnancy with risk of rupture and hemoperitoneum. A 37-year-old woman came with missed period and vague abdominal discomfort; she had a positive pregnancy test. She had previous two cesarean sections. The last cesarean section was 12 years ago and the patient was not using any contraception. Her ultrasonography (USG) was inconclusive; β human chorionic gonadotropin was 2,980 mIU/mL. Her repeat USG showed a hypoechoic area at the cesarean scar site, behind the reflection of bladder, separated from bladder by a thin layer of myometrium. She was counseled regarding the management options and prognosis. She was managed with two doses of injection. Methotrexate on day 1 and day 4. β human chorionic gonadotropin was repeated until it was close to normal. USG was also repeated. Cesarean scar pregnancy can be managed by many ways; the one most suitable to the patient with least side effects should be adopted, after adequate counseling of the patient.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.