Imperfect twinning: a clinical and ethical dilemma

Abstract

OBJECTIVE To review the history, epidemiology, etiology, gestational aspects, diagnosis and prognosis of imperfect twinning. DATA SOURCES Scientific articles were searched in PubMed, SciELO and Lilacs databases, using the descriptors "conjoined twins", "multiple pregnancy", "ultrasound", "magnetic resonance imaging" and "prognosis". The research was not delimited to a specific period of time and was supplemented with bibliographic data from books. DATA SYNTHESIS: The description of conjoined twins is legendary. The estimated frequency is 1/45,000-200,000 births. These twins are monozygotic, monochorionic and usually monoamniotic. They can be classified by the most prominent fusion site, by the symmetry between the conjoined twins or by the sharing structure. The diagnosis can be performed in the prenatal period or after birth by different techniques, such as ultrasound, magnetic resonance imaging and echocardiography. These tests are of paramount importance for understanding the anatomy of both fetuses/children, as well as for prognosis and surgical plan determination. CONCLUSIONS Although imperfect twinning is a rare condition, the prenatal diagnosis is very important in order to evaluate the fusion site and its complexity. Hence, the evaluation of these children should be multidisciplinary, involving mainly obstetricians, pediatricians and pediatric surgeons. However, some decisions may constitute real ethical dilemmas, in which different points should be discussed and analyzed with the health team and the family.

Ausência Bilateral Do Músculo Quadrado Femoral – Relato De Caso

“…Anais da XIII Jornada de Ensino, Pesquisa e Extensão. Recife, 2013 DANIEL, 2008). A maioria das reações biomoleculares de células e tecidos do sistema nervoso necessita de proteína, então quando o indivíduo é submetido a uma dieta com restrição protéica isso resulta em alterações morfológicas e fisiológicas (SCHOFFEN et al, 2005).…”

“…Os dois grupos foram corados pela técnica de Hematoxilina e Eosina. Na etapa de montagem da lâmina foi utilizado no grupo Tratado I o álcool Petrobras BR®, nas concentrações de 70%, 100% I, 100%II e 100% III seguido de seis minutos na estufa a 75°C, adaptando a metodologia de Cazari et al(2013); e no Tratado II foi utilizado o álcool Isofar®, nas concentrações de 70%, 100% I, 100% II. As lâminas obtidas foram fotografadas utilizando-se câmara Olympus SC30 acoplada a um microscópio ótico trinocular Olympus CX31.…”

Pre- and postnatal findings of a dicephalus tetrabrachius-dipus conjoined twins with a diaphragmatic hernia

“…Imperfect twinning occurs in approximately one per 250,000 live births ( 1 , 2 ) and is classified according to the fusion site added by the term pagus ( 3 ) . "Parapagus" twins (meaning "extensive lateral fusion") correspond to 28% of cases of conjoined twins ( 4 ) .…”

“…On the other hand, MRI represents a good complementary tool since it does not present such limitations, while providing images with better resolution ( 6 ) . Additionally, it serves as support for a possible surgical planning, since it allows for visualization and detection of abnormalities which otherwise would be missed or inconclusive at US ( 2 ) . In the present case, MRI was relevant, particularly in the determination of the type of imperfect twinning as well as of the extent of fusion and sharing of organs.…”