Conjoined twins in a spontaneous monochorionic triplet pregnancy

Gao, Qianqian; Pang, Houqing; Luo, Hong

doi:10.1097/md.0000000000024490

Cited by 4 publications

(4 citation statements)

References 30 publications

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“…We also found 3 cases of deaths after selective foeticide in advanced pregnancy. Two cases occurred after microwave ablation of the umbilical cord [11,12] and one after endoscopic laser occlusion [13]. In our case, the parents decided to continue the pregnancy, which resulted in the spontaneous death of CTs at 30 weeks of pregnancy and favourable outcome with the birth of the late premature baby at week 36 of gestation.…”

Section: Discussionmentioning

confidence: 77%

Conjoined twins in the course of a triplet dichorionic diamniotic pregnancy

Młodawski¹,

Pliszka²,

Mlodawska³

et al. 2023

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Conjoined twins (CT) is an extremely rare complication in a monoamniotic twin pregnancy, affecting approximately 1 in 80,000 births. In our case report, we present the occurrence of this complication in a patient with a triple dichorionic pregnancy. The complication was diagnosed in the 15 th week of pregnancy. The degree of organ connection in CT did not predict the survival of the conjoined foetuses after delivery. The third foetus was morphologically normal and had a separate chorion. The patient did not decide to undergo selective CT foeto-reduction in the second trimester. The natural course resulted in spontaneous intrauterine death of the affected foetuses in the 30 th week of pregnancy, followed by spontaneous preterm labour in the 36 th week of pregnancy. The description of the case along with photographic documentation allows the diagnosis, procedure, and the spontaneous course of pregnancy with such a complication to be traced. The attached discussion deals with similar descriptions of such rare cases in the literature and proceedings. StreszczenieBliźniaki zrośnięte (CT) to skrajnie rzadkie powikłanie występujące w ciąży bliźniaczej jednoowodniowej, dotykające około 1 na 80 000 ciąż. W niniejszej pracy przedstawiamy przypadek pacjentki w ciąży trojaczej dwukosmówkowej, u której zdiagnozowano to powikłanie w 15. tygodniu ciąży. Stopień połączenia narządów u bliźniaków nierozdzielonych nie rokował ich przeżycia po porodzie. Trzeci płód był morfologicznie prawidłowy i posiadał oddzielny worek owodniowy i kosmówkę. Pacjentka nie zdecydowała się na selektywną terminację płodów nierozdzielonych w drugim trymestrze. Naturalny przebieg skutkował spontaniczną wewnątrzmaciczną śmiercią chorych płodów w 30. tygodniu ciąży, po czym nastąpił spontaniczny poród przedwczesny w 36. tygodniu ciąży. Opis przypadku wraz z dokumentacją fotograficzną pozwala na śledzenie diagnostyki, postępowania i naturalnego przebiegu ciąży z tym rzadkim powikłaniem. W dyskusji omówiono również podobne przypadki opisane w literaturze oraz sposoby postępowania w takiej sytuacji.

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Section: Discussionmentioning

confidence: 77%

Conjoined twins in the course of a triplet dichorionic diamniotic pregnancy

Młodawski¹,

Pliszka²,

Mlodawska³

et al. 2023

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“…The prognosis of this type of pregnancy is poor. Meng et al (2018) reviewed the literature and found eight cases of triplet monochorionic pregnancy with conjoined fetuses, we reviewed Pubmed and found another three reports in addition to the present case (Gao et al, 2021;Wax et al, 1999;Zeng et al, 2002). Two cases of triplet monochorionic pregnancy with conjoined fetuses and a third acardiac fetus were excluded (Chang et al, 1996;Yuan et al, 2017).…”

Section: Discussionmentioning

confidence: 88%

“…Even more uncommon are the triplet pregnancies with a pair of conjoined fetuses. These incidences occur close to one in a million deliveries (Gao et al, 2021), with one or two cases published annually since 1948, and a total of less than 100 cases (Oostra et al, 2022; Sepulveda et al, 2003). In this exclusive group, the majority are dichorionic, only 11 cases of monochorionic diamniotic pregnancies with conjoined fetuses have been reported, which seems to be the group with the worst prognosis (Talebian et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Monochorionic triplet pregnancy complicated by conjoined twins and early twin–twin transfusion syndrome

Bustos,

Vera,

Ahumada

et al. 2024

Birth Defects Research

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BackgroundThe condition of monozygotic, monochorionic triplet fetuses with a pair of conjoined twins is extremely rare (close to one in a million births), presents challenges in its management, and with poor prognosis.Case reportWe report a case of monochorionic diamniotic triplet pregnancy, ultrasound at 14 weeks shows a pair of conjoined thoracopagus fetuses, sharing heart, liver, and umbilical cord, in addition to omphalocele. The third fetus, without malformations, presents signs of early heart failure compatible with twin‐to‐twin transfusion syndrome. It was decided to carry out expectant management where at 18 weeks, intrauterine death of the three fetuses occurs. An abortion is performed by hysterotomy.ConclusionsThe treatment in these cases is discussed, three management options have been proposed: expectant management, selective reduction of the conjoined fetuses, or termination of the pregnancy. A review of the literature found only 12 cases with this combination of pathologies, in which only 3 normal fetuses (25%) survived and none of the conjoined twins survived. To our knowledge, this case is the first of a monochorionic triplet pregnancy with conjoined fetuses complicated with early twin‐to‐twin transfusion.

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“…Detailed information is shown in Table 1 . We found 14 cases of monochorionic triplet pregnancies with conjoined twins [ 25 – 38 ]. Detailed information is shown in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

Conjoined twins in dichorionic diamniotic triplet pregnancy: a report of three cases and literature review

Liu

Deng

et al. 2021

BMC Pregnancy Childbirth

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Background Conjoined twins are a rare and serious complication of monochorionic twins. The total incidence is 1.5 per 100,000 births, and about 50% are liveborn. Prenatal screening and diagnosis of conjoined twins is usually performed by ultrasonography. Magnetic resonance imaging can be used to assist in the diagnosis if necessary. Conjoined twins in dichorionic diamniotic triplet pregnancy are extremely rare. Case presentation We reported three cases of dichorionic diamniotic triplet pregnancy with conjoined twins. Due to the poor prognosis of conjoined twins evaluated by multidisciplinary teams, selective termination of conjoined twins was performed in three cases. In case 1, selective reduction of the conjoined twins was performed at 16 gestational weeks, and a healthy female baby weighing 3270 g was delivered at 37 weeks. In case 2, the conjoined twins were selectively terminated at 17 weeks of gestation, and a healthy female baby weighing 2760 g was delivered at 37 weeks and 4 days. In case 3, the conjoined twins were selectively terminated at 15 weeks and 2 days, and a healthy female baby weighing 2450 g was delivered at 33 weeks and 6 days. The babies of all three cases were followed up and are in good health. Conclusion(s) Surgical separation is the only treatment for conjoined twins after birth. Early determination of chorionicity and antenatal diagnosis of conjoined twins in triplet gestations are critical for individualized management options and the prognosis of normal triplets. Expecting parents should be extensively counseled by multidisciplinary teams. If there are limitations in successful separation after birth, early selective termination of the conjoined twins by intrathoracic injection of potassium chloride may be a procedure in dichorionic diamniotic triplet pregnancy to improve perinatal outcomes of the normal triplet.

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Conjoined twins in a spontaneous monochorionic triplet pregnancy

Cited by 4 publications

References 30 publications

Conjoined twins in the course of a triplet dichorionic diamniotic pregnancy

Conjoined twins in the course of a triplet dichorionic diamniotic pregnancy

Monochorionic triplet pregnancy complicated by conjoined twins and early twin–twin transfusion syndrome

Conjoined twins in dichorionic diamniotic triplet pregnancy: a report of three cases and literature review

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