Diagnosis of conjoined twins in the first quarter of pregnancy

Κalampokas E(1), Κalampokas T(2), Τourountous J(1), Κatopodis D(1).

(1) Dept. of Ob/Gynecology Thriasio Hospital
(2) Dept. of Ob/Gynecology Aretaieio Hospital

Correspondence: 18 Estias street, Athens 11526,

E-mail: m.kalampokas@gmail.com

 


 

 

Abstract

Conjoined twins is a rare complication of monozygotic twinning, which is associated with high perinatal mortality. Early prenatal diagnosis of conjoined twins allows better counseling of the parents and better management of the pregnancy including termination of the pregnancy(medical or surgical), post-natal surgery for the separation of conjoined twins and selective fetocide in case of a triplet pregnancy.
In the department of Obstetrics and Gynecology, of Thriasio Hospital we came up with one case of conjoined twins in a 25 years old woman. Her previous medical, social, obstetrical and gynecologic history was free of disease. The final diagnosis of conjoined twinning came by transvaginal ultrasound examination at 7 week and 5 days of pregnancy. The parents decided the termination of the pregnancy by suction
curettage, after the doctor's counseling for all different possibilities. With the introduction of high resolution transvaginal ultrasound imaging, accurate prenatal diagnosis of conjoined twins is possible early in pregnancy.
Although first-trimester diagnosis of conjoined twins is feasible, false positive cases are common before 10 weeks because, earlier in gestation, fetal movements are limited and monoamniotic twins may appear conjoined. As most parents choose immediate termination of pregnancy at confirmation of the diagnosis, as it happened in our case, there are limited data on the prenatal follow up of conjoined twins. When the parents choose the continuation of the pregnancy half of the fetuses die in utero and another 44% will die in neonatal period.

Key words: Multiple pregnancy; coupled twins; conjoined twins.