• 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.

References
1. Barrett JF, Hannah ME, Hutton EK et al. (2013, Oct 3). A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy. N Engl J Med. 369(14): 1295—1305. https://doi.org/10.1056/NEJMoa1214939; PMid:24088091 PMCid:PMC3954096

2. Sharma UK, Dangol A, Chawla CD, Shretha CD. (2007). Antenatal detection of conjoined twin. J Nepal Med Assoc. 46: 133—135. PMid:18274570

3. Brizot ML, Liao AW, Lopes LM. (2011, Dec). Conjoined twins pregnancies: experience with 36 cases from a single center. Prenatal Diagnosis. 31; Is 12: 1120—1125.

4. Caesarean section; NICE Clinical Guideline. (2011, Nov). https://www.nice.org.uk/guidance/cg132.

5. Christopher D, Robinson BK, Peaceman AM. (2011). An evidence-based approach to determining route of delivery for twin gestations. Rev Obstet Gynecol. 4(3—4): 109—116. PMid:22229063 PMCid:PMC3252881

6. Chiabi A, Nkemayim D, Tchokoteu P-F et al. (2009). Conjoined twins in Cameroon: issues inherent in diagnosis and management in the African context. Afr J Reprod Health. 3: 127—135.

7. Cuillier F, Dillon KC, Grochal F et al. (2012, Jan-Mar). Conjoined twins: what ultrasound may add to management. J Prenat Med. 6(1): 4—6. PMid:22905303 PMCid:PMC3414243.

8. Maymon R, Mendelovic S, Schachter M et al. (2005, Sep). Diagnosis of conjoined twins before 16 weeks' gestation: the 4-year experience of one medical center. Prenatal Diagnosis. 25; Is 9: 839—843.

9. Makhoul IR, Goldsher D, Okopnik M, Bronshtein M. (2003). Early prenatal diagnosis of conjoined cephalopagus twins. Isr Med Assoc J. 5: 530—531. https://doi.org/10.1002/pd.550; PMid:12627419

10. Hofmeyr G.J. J.F. Barrett, C.A. Crowther (2015, Dec 19).  Planned caesarean section for women with a twin pregnancy. Cochrane Database Syst Rev. 12: CD006553. https://doi.org/10.1002/14651858.CD006553.pub3.

11. Lee YM. (2012, Jun). Delivery of twins. Semin Perinatol. 36(3): 195—200. https://doi.org/10.1053/j.semperi.2012.02.004.

12. Royal College of Obstetricians and Gynaecologists (2008, Dec). Management of monochorionic twin pregnancy. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg51.

13. McHugh K, Kiely EM, Spitz L. (2006). Imaging of conjoined twins. Pediatr Radiol. 36: 899-910. https://doi.org/10.1259/imaging/30228599; https://doi.org/10.1259/imaging/14205638

14. McMahon CJ, Spencer R. (2006). Congenital heart defects in conjoined twins: outcome after surgical separation of thoracopagus. Pediatr Cardiol. 27: 1—12. https://doi.org/10.1007/s00246-005-0835-5; PMid:16391976

15. Pajkrt E, Jauniaux E. (2005, Sep). First-trimester diagnosis of conjoined twins. Prenatal diagnosis. 25; Is 9: 820—826.

16. Boyle B, McConkey R, Garne E et al. (2013, May). Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984—2007. BJOG. 120(6): 707—716. https://doi.org/10.1111/1471-0528.12146. Epub 2013 Feb 6.

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