Early unexpected diagnosis of fetal life-limiting malformation; antenatal palliative care and parental decision

Abstract

Cesarean delivery of a set of conjoined twins and a singleton at 34 weeks' gestation. Immediate neonatal death of the conjoined twins, intact survival, and discharge of the singleton. Review of the database on previously reported similar cases. It is very important to utilize simple and direct language for parents to understand the grave prognosis to the pregnancy. Care alternatives in view of the maternal physical risks and psychological impact of carrying a high order abnormal multiple pregnancy, along with the possible side effects on the singleton.

Conjoined Twins in a Spontaneous Monochorionic Triplet Pregnancy

“…To date, seven cases of monochorionic triplet pregnancies complicated with conjoined twins and a normal fetus have been reported previously. [ 4 5 6 7 8 9 10 ] The relevant information of the seven cases and our case are presented in Table 1 .…”

“…[ 8 9 ] One (12.5%) was achieved by intracytoplasmic sperm injection (ICSI) and the transfer of three frozen-thawed blastocysts,[ 9 ] while the other 7 (87.5%) women had spontaneous triplet pregnancies. [ 4 5 6 7 8 10 ] Chorionicity was confirmed prenatally and classified as monochorionic diamniotic in all cases. [ 4 5 6 7 8 9 10 ] Prenatal ultrasound diagnosis of conjoined twins in a triplet pregnancy was made in the first trimester in 5 (62.5%) of the cases[ 5 6 7 9 10 ] and in the second trimester in the other three.…”

“…[ 4 5 6 7 8 10 ] Chorionicity was confirmed prenatally and classified as monochorionic diamniotic in all cases. [ 4 5 6 7 8 9 10 ] Prenatal ultrasound diagnosis of conjoined twins in a triplet pregnancy was made in the first trimester in 5 (62.5%) of the cases[ 5 6 7 9 10 ] and in the second trimester in the other three. [ 4 8 ] The types of conjoined twins included two cases of cephalopagus,[ 6 7 ] two cases of thoraco-omphalopagus,[ 9 ] and one case each of thoracopagus,[ 4 ] xipho-omphalopagus,[ 8 ] thoraco-omphalo-ischiopagus[ 5 ] and parapagus.…”

“…[ 4 8 ] The types of conjoined twins included two cases of cephalopagus,[ 6 7 ] two cases of thoraco-omphalopagus,[ 9 ] and one case each of thoracopagus,[ 4 ] xipho-omphalopagus,[ 8 ] thoraco-omphalo-ischiopagus[ 5 ] and parapagus. [ 10 ]…”

“…[ 7 8 ] Two women opted to continue the pregnancy, and they proceeded well. [ 5 10 ] In case 2, the patient gave birth to the conjoined twins and a normal female infant weighing 2041 g by cesarean section at 36 weeks of gestation. The conjoined female infants died 1 h apart at the age of 6 months.…”