Prenatal Diagnosis and Management of Conjoined Fetuses
Themistoklis Mikos, Apostolos Athanasiadis, Menelaos Zafrakas
Conjoined twins,conjoined triplets,prenatal diagnosis,magnetic resonance imaging,surgical separation,fetal echocardiography
Citation Information :
Mikos T, Athanasiadis A, Zafrakas M. Prenatal Diagnosis and Management of Conjoined Fetuses. Donald School J Ultrasound Obstet Gynecol 2007; 1 (1):96-104.
CC BY-NC 4.0
Copyright © 2007; Jaypee Brothers Medical Publishers (P) Ltd.
Conjoined twins have an estimated incidence of one in 50,000 to one in 100,000 births. The first cases of prenatal diagnosis of conjoined twins using B-mode ultrasound were reported in the 1970s, followed by prenatal real-time ultrasonographic diagnosis shortly thereafter. Since then, real-time ultrasound has been the most reliable method in establishing prenatal diagnosis of conjoined twins and in detecting associated anomalies. Moreover, recent improvements in real-time ultrasound technology - in some cases coupled with use of Magnetic Resonance Imaging (MRI) - have made early diagnosis of conjoined fetuses in the first trimester possible. Prenatal diagnosis of conjoined fetuses is considered essential for further management. Parents need detailed counseling in order to decide among various management options, which include the following: (a) pregnancy continuation and scheduled neonatal surgery, (b) termination of pregnancy, and (c) multifetal pregnancy reduction or selective fetocide in cases of high-order multifetal pregnancies with a component of conjoined fetuses. An interdisciplinary medical team, involving obstetricians, neonatologists, pediatric surgeons and anesthetists, should carefully approach and assist parents in their decisions. In special cases, additional consultation may be given by other specialists, even from specialized centers in other countries, depending on the area of conjunction, the involvement of other organ systems, and the presence of associated anomalies.
Biographical notes on some famous conjoined twins. Birth Defects 1967;3:10-17.
Prenatal ultrasound diagnosis of conjoined twins. Obstet Gynecol Survey 1994;49:656-62.
Xiphopagus conjoined twins: a 300-year review of the obstetric, morphopathologic, neonatal, and surgical parameters. Am J Obstet Gynecol 1980;137:617-29.
Prapartale Diagnose eines Thoracopagus mittels Ultrasonographie. Gynakologe 1979;12:64.
Thoracopagus twins: prenatal diagnosis. Radiology 1950;54:398.
Conjoined twins: prenatal diagnosis and assessment of associated malformations. Radiology 1990;177:201-7.
The prepartum diagnosis of conjoined twins by the use of diagnostic ultrasound. Am J Obstet Gynecol 1976;126:737.
Antepartum diagnosis of conjoined twins by ultrasonography. Am J Roentgenol 1977;129:921-2.
B-scan and realtime ultrasound in the antepartum diagnosis of conjoined twins and pericardial effusion. Am J Roentgenol 1978;130:578-80.
Realtime ultrasound diagnosis of conjoined twins. J Clin Ultrasound 1981;9:195-7.
Antepartum ultrasonographic diagnosis of conjoined twins in early pregnancy. Am J Obstet Gynecol 1981;139:961-3.
Early diagnosis of severe congenital malformations by ultrasonography. J Perinat Med 1982;10:233-41.
Early diagnosis of conjoined twins in triplet pregnancy after in vitro fertilization and assisted hatching. J Ultrasound Med 1995;14:611-5.
The sonographic detection of early first-trimester conjoined twins. Prenatal Diagnosis 1997;17:961-3.
Prenatal sonographic diagnosis of conjoined twins in the first trimester: two case reports. Ultrasound Obstet Gynecol 1998;11:289-91.
First trimester diagnosis of conjoined twins in a triplet pregnancy after IVF and ICSI: case report. Hum Reprod 2000;15:1413-5.
First trimester diagnosis of dicephalus conjoined twins. Eur J Obstet Gynecol Reprod Biol 2004;112:110-13.
The natural history of prenatally diagnosed conjoined twins. J Pediatr Surg 2002;37:303-9.
A unique case of conjoined triplets. Am J Obstet Gynecol 2005;192:2084-7.
Conjoined twins in a triplet pregnancy. Am J Dis Child 1971;122:455-8.
Conjoined twins in a triplet pregnancy: early prenatal diagnosis with three-dimensional ultrasound and review of the literature. Ultrasound Obstet Gynecol 2003;22:199-204.
Incidence of conjoined twinning. Lancet 1975;2:1257.
Conjoined twins in the United States 1970-1977. Teratology 1982;25:301-8.
The epidemiology of conjoined twinning in Southern Africa. Clin Genet 1983;24:15-21.
Theoretical and analytical embryology of conjoined twins: part I: Embryogenesis. Clin Anat 2000;13:36-53.
Prenatal diagnosis of conjoined twins. Am J Obstet Gynecol 1984;148:343-4.
Conjoined twins in a monozygotic triplet pregnancy: prenatal diagnosis and X-inactivation. Teratology 2002;66:278-81.
Mechanisms oftwinning. V. Conjoined twins, stem cells and the calcium model. J Reprod Med 2002;47:313-21.
Monozygotic twinning in human is associated with zona pellucida architecture. Hum Reprod 1994;9:1318-21.
Identical twins and in vitro fertilization. J In Vitro Fertil Embryo Tranfer 1986;3:114-7.
First-trimester diagnosis of conjoined twins. Prenat Diagn 2005;25:820-6.
Prenatal diagnosis of conjoined twins. Prenat Diagn 1983;3:357-61.
Dicephalus: unusual case of conjoined twins and its prepartum diagnosis. Am J Obstet Gynecol 1984;149:693-4.
Prenatal ultrasound diagnosis of thoracopagus conjoined twins. J Clin Ultrasound 1987;15:59-63.
Three-dimensional ultrasound to differentiate epigastric heteropagus conjoined twins from a TRAP sequence. Am J Obstet Gynecol 2004;191:1736-9.
Early second-trimester sonographic diagnosis of thoracopagus twins. J Clin Ultrasound 1986;14:207-8.
Fruhe Ultraschall-diagnose des Thorakopagus. Z Geburtshilfe Perinatol 1988;192:38-41.
Conjoined twins and their separation. Semin Perinatol 1986;10:82-91.
Hemodynamic analysis of cephalothoracopagus by the color Doppler method. A comparison to normal fetuses via a longitudinal study. Fetal Diagn Ther 2006;21:61-4.
Cardiovascular abnormalities in thoracopagus twins: embryological interpretation and review. Early Hum Dev 1987;15:33-44.
Early cardiac evaluation of thoracically conjoined twins. Cardiology 1983;70:152-5.
Separation of conjoined thoracopagus twins joined at the right atria. Am J Cardiol 1979;43:662-5.
Echocardiographic assessment of conjoined twins. Heart 2006;92:382-7.
Prenatal diagnosis of congenital heart defects in thoracoabdominally conjoined twins. N Engl J Med 1985;313:370-4.
McGraw-Hill: New York 2000;892-99.
Prenatal diagnosis of conjoined twins with real-time ultrasound. Clin Med J 1988;101:58.
The obstetrical management of conjoined twins. Obstet Gynecol 1979;53:67S-72S.
Prenatal Ultrasonographic diagnosis of dicephalus conjoined twins. Can Assoc Radiol J 1991;42:357-9.
Obstetric management of conjoined twins. Obstet Gynecol 1986;67:S21-25.
Bioethical issues in caring for conjoined twins and their parents. Lancet 2001;357:1968-71.
Emergency separation of newborn conjoined (Siamese) twins. Tex Med 1980;76:60-2.
Surgical experience with thirteen conjoined twins. Ann Surg 1988;208:299-312.
Separation of thoracopagus conjoined twins. A case report. J Cardiovasc Surg (Torino) 1994;35:459-62.
Success rate for surgery of conjoined twins. Lancet 2000;356:1765.
Prenatal management and postnatal separation of omphalopagus and craniopagus conjoined twins (Submitted for publication).
Craniopagus: the Thessaloniki-Rome experience. Childs Nerv Syst 2004;20:576-86.