• Conjoined twins: diagnostics and obstetric tactics

Conjoined twins: diagnostics and obstetric tactics

PERINATOLOGIYA I PEDIATRIYA. 2017.2(70):25-31; doi 10.15574/PP.2017.70.25

Davydova Iu. V., Ogorodnyk А. А., Lukyanova I. S., Siromaha S. O.
SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv
SI «National Institute of Cardiovascular Surgery named after N.M. Amosova of the NAMS of Ukraine», Kyiv

Rationale. Conjoined twin is a rare and complex congenital malformation with severe mortality and morbidity. The more common type of conjoined twins is thoracopagus that is fused at the frontal plane of a thorax and often involves the heart. The article reports a case of conjoined thoracopagus twins that were diagnosed by ultrasonography at the 3rd trimester of pregnancy. The early diagnosis of conjoined twins allows providing reasonable obstetric tactics and informing parents about options for monitoring, abortion on therapeutic grounds (including selective feticide with triple), delivery time and its mode if a decision of pregnancy prolongation is made. The assessing of possibility and type of prearranged planned postpartum surgery is important in such a case as well.

Case Report. Pregnant woman was diagnosed with conjoined twins, thoracopagus, by ultrasonography at 29 weeks of gestation, when she was admitted to our clinic at the Department of pathology of pregnancy and childbirth. At 32 weeks of gestation, the cesarean section with precise prophylactics of uterine damage and excessive bleeding was performed. The newborns with multiple congenital malformations of heart, lungs, liver, intestine and bowel died in the intensive care unit from a rapidly progressing and uncontrollable cardiac and respiratory failure. The postoperative period was within normal.

Conclusions. Diagnosis of conjoined twins should be carried out at the first trimester of pregnancy. Provision of perinatal care for this pathology should be carried out in a maternity institution with a compulsory participation of a multidisciplinary team of neonatologists, intensivists, pediatric surgeons.

Key words: conjoined twins, thoracopagi, pregnancy, multidisciplinary team.

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