Diagnosis of conjoined twins at 10 weeks using three-dimensional ultrasound: a case report.

A case report is presented of the prenatal diagnosis of conjoined twins at 10 weeks and 2 days' gestation using three-dimensional ultrasound (3D US). The multiplanar display coupled with 3D US surface rendering clearly confirmed the presence of craniopagus. The twins were facing in opposite directions with the left occipital region of one embryo fused with the left parietal-temporal region of the other. Additional multiplanar analysis above the level of the biparietal diameter demonstrated brain sharing.     

Staged separation of craniopagus conjoined twins: a multidisciplinary approach

During 2003 and 2004, a multidisciplinary team at the Children's Hospital at Montefiore, Bronx, New York, successfully separated twin infants who presented with a total craniopagus vertical O'Connell type 1 conjoining. The twins underwent a series of four staged separation procedures over 10 months. The first three stages involved performing gradual circumferential craniotomies, dividing the dura, ligating large and small bridging veins, separating abutting brains, and inserting skin expanders. The fourth stage involved dividing the remaining dura and veins, transecting shared brain tissue not detected in preoperative imaging, replacing dura in twin B, and replacing skin over native dura in twin A. Planning and carrying out separation of the conjoined twins required organization and cooperation of all the disciplines involved to prepare the children preoperatively, care for them perioperatively and postoperatively, and support the mother during the process.     

连颅双胎畸形影像表现与手术对照(及文献复习)

目的报道1例连颅双胎罕见畸形并复习文献,提高对连颅双胎畸形的认识。方法一对女性连颅双胎婴儿的影像学表现,与手术对照。结果影像学表现与手术所见一致。结论现代影像发展可发现复杂畸形,对其矫形手术具有重要意义。     

12例联体双胎的产前超声诊断

目的 报告12例联体双胎的超声特征.方法 回顾性分析2003-2008年我科诊断并经病理证实的12例联体双胎.结果 12例中对称性联体双胎10例,其中胸腹部联体5例,头部联体3例,侧面联体1例,骶尾部联体1例;不对称性联体双胎(寄生胎)2例;女7例,男2例,性别不明3例;脐血管数目异常8例.胸腹部联体超声特征大体相近;头部联体表现多样;寄生胎较为特殊.结论 产前超声检查能为联体双胎的诊断提供重要信息;不同类型联体双胎的超声特征有助于提高诊断水平.     

Thermocoagulation for selective reduction of conjoined twins at 12 weeks of gestation.

Conjoined twins occur rarely. Most of the prenatally diagnosed cases are terminated either because of extensive organ sharing or because of the presence of major structural abnormalities. We present a case of omphalopagus conjoined twins diagnosed at 10 weeks of gestation with selective reduction performed at 12 weeks. The twins were conjoined at the umbilicus with vascular communication demonstrated at the conjunction. Twin A was normal but twin B was growth restricted and hydropic. Thermocoagulation of twin B was performed at 12 weeks by passing an insulated electric wire through a 18-gauge needle placed close to the fetal heart. Reassessment at 15 weeks showed that twin A was growing normally with a small dead twin B attached at its umbilicus. Twin B was subsequently sloughed off from this attachment and could be seen lying free in the amniotic cavity at 17 weeks. Twin A was delivered at term and was healthy. A small scar could be seen just above the umbilical cord insertion. This case represents the first antenatal example of selective reduction of conjoined twins by thermocoagulation.     

B型超声检查对联体双胎的诊断价值

目的 探讨B型超声检查对联体双胎的诊断价值.方法 回顾性分析2008年-2010年产前诊断为联体双胎的8例孕妇B型超声声像图资料,总结其声像表现.结果 对称性联体双胎8例,其中胸腹部联体6例,头部联体2例.结论 产前B型超声检查能为联体双胎的诊断提供重要临床信息,并可做出不同类型的诊断.     

联体双胎分离术前影像学综合评价

目的对联体双胎(Conjoined Twins,CT)分离术前的影像学资料进行综合评价,确定手术的可行性及其方案。方法对两对(四婴)联体双胎在分离术前的影像学资料进行综合分析。结果两对联体双胎中肝脏均为联体融合畸形,其中一对为心脏融合畸形,另外一对为两个心脏,共用一个心包。X线、CT、MRI、超声学检查诊断比较准确、全面地显示了患儿联体畸形的解剖部位、联结面积程度和相关的解剖学关系。结论影像学诊断能比较全面的显示相连脏器的程度、血管沟通情况,有助于术前手术设计。联体双胎术前影像学检查有较高价值,是联体双胎分离手术的关键环节之一。     

Two-dimensional and three-dimensional sonography of conjoined twins

PURPOSE: The aim of this study was to evaluate and compare the diagnostic capabilities of 2-dimensional (2D) and 3-dimensional (3D) sonography for the study of conjoined twins. METHODS: Four pregnant women with an initial 2D sonographic diagnosis of conjoined twins were examined with color Doppler sonography, 3D multiplanar sonography, and orthogonal plane imaging and 3D surface rendering. RESULTS: All 4 cases of conjoined twins were initially diagnosed with either transvaginal or transabdominal 2D sonography. 3D sonography afforded more realistic views and demonstrated more clearly the linking areas and surface anomalies, but 2D and color Doppler sonography provided more definitive and specific information about shared organs. CONCLUSIONS: Although 2D sonography is the primary modality for diagnosing and evaluating conjoined twins, color Doppler and 3D sonography can sometimes provide additional information that assists in the clinical management of these twins. 3D sonography also provides images that are easier for parents to understand, which can help them with decision making.     

联体儿的影像学评估及应用

目的：通过对以往病例的回顾，发现适用于联体儿诊断的影像学检查方法，为手术做准备，提高术后生存率。方法：观察以往病例的影像学检查，对照手术及病理进行比较。结果：6例联体儿中5例胸腹联体，1例坐骨联体，5例胸腹联体均为肝脏及胸骨融合，所有患儿均有不同程度的先天性心脏病， 1例坐骨联体两个患儿共用一条直肠，手术结果与影像诊断大致一致。结论：通过适用的影像学检查，能够全面的了解联体儿内部的结构异常情况，对手术的难度、手术的选择、术前准备、预后评估有重要意义。     

联体双胎的早孕期超声诊断

目的探讨联体双胎早孕期超声声像图特征,总结早孕期超声诊断联体双胎的技巧。 方法对2011年1月至2017年12月因早孕期先兆流产在深圳市妇幼保健院超声筛查发现颈项透明层（NT）增厚、规范化超声筛查诊断为联体双胎21例胎儿的超声声像特征、联体部位、联体类型、合并畸形及妊娠结局进行分析,总结早孕期超声诊断联体双胎的技巧。 结果早孕期超声诊断的21例联体双胎平均头臀径相当于平均孕周;8例获得较满意的NT测量,其中7例NT厚度大于0.3 cm;21例双胎联体部位及联体类型：胸脐联胎12例（12/21）,头部联胎3例（3/21）,双头联胎3例（3/21）,脐部联胎2例（2/21）,坐骨联胎1例（1/21）。21例联体双胎二维超声检出合并脊柱畸形、单心室、腹裂、膈疝、脐膨出、脊柱裂等其他畸形;三维超声对联体类型和范围及外观特征的观察更直观。妊娠结局：21例联体双胎中4例胎死宫内,17例超声检查后孕妇选择终止妊娠,产后标本检查证实21例均为联体双胎。 结论早孕期超声检查可对联体类型及合并畸形做出明确诊断,有利于孕妇进行产前咨询。     

医学影像学在诊断先天性联体畸形中的价值

目的：探讨医学影像学在诊断先天性联体畸形中的价值，以便做好分离术前准备。材料与方法：收集我院两例联体婴儿的消化道造影、CT、MRI、核医学等影像学资料，分析各自特异性表现。结果：联体婴儿1肝脏相连，心包有轻度的粘连，相连的肝脏没有大血管交通，其代谢、功能正常，各自具有完整独立的胆道系统、消化系统、泌尿系统。联体婴儿2心脏、肝脏相连,其它部位没有相连。结论：联体婴儿的影像学资料比较全面地反映了相连脏器的相连程度及其血管沟通和代谢、功能情况，能够较准确地指导分离手术方案的制定,医学影像检查的综合应用是联体畸形分离术成功的重要保障。     

Prenatal evaluation of cephalopagus conjoined twins by means of three-dimensional ultrasound at 13 weeks of pregnancy.

Cephalopagus twinning, an extremely rare type of conjoined twins, is characterized by the anterior union of the upper half of the body, with two faces each situated on the opposite side of a conjoined head. The prognosis for cephalopagus twins is extremely poor because surgical separation is not an option. Thus early prenatal diagnosis of cephalopagus twins is important to provide an opportunity for pregnancy termination if desired. However, in many instances, cephalopagus twins are misdiagnosed as a singleton pregnancy because of the extreme degree of fusion which makes accurate demonstration of the abnormalities very difficult. This report presents a case of cephalopagus twins which was confirmed at 13 weeks of gestation using three-dimensional ultrasound.     

Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review

After an unsuccessful midwife-assisted delivery in which a head was born but delivery could not be advanced, episiotomy performed at Sanliurfa Maternity Hospital allowed vaginal delivery of female conjoined twins. Visual and x-ray examination showed two heads, two vertebral columns, two feet, two arms, and fusion at the level of the pelvis. The baby was born dead, but the mother made an uneventful recovery. Parapagus (anterolaterally joined) dicephalus (two-headed) twins account for only 11-13% of all conjoined twins, and they rarely survive. Complex malformations of hearts, lungs and abdominal organs, duplication of the tracheae, upper gastrointestinal tract and spinal column, and either double or single versions of other organs have been reported in parapagus dicephalus cases. The incidence, anatomical, embryological, diagnostic, prognostic, obstetrical, perinatal, and ethical aspects of conjoined twins are reviewed, with a focus on parapagus dicephalus conjoined twins.     

胸腹联体儿分离术后的早期监护

目的　探讨胸腹联体双胎婴儿分离术后早期监护特点。方法　 1例胸腹联体婴儿在 96d时接受分离手术 ,术后进住监护室 ,进行特别护理。分析呼吸道支持和管理 ,肝脏功能观察与保护 ,创缘的观察与处理 ,营养支持与喂养等特点。结果　经过严密观察 ,及时对症处理 ,两婴均无严重并发症 ,顺利转出监护室 ,并痊愈出院。结论　胸腹联体双胎婴儿极为罕见 ,分离术后加强早期监护是保障手术成功的重要环节     

Separation of conjoined twins: experiences of perioperative nurses and their recommendations

BACKGROUND: Within an 8-month period, an unprecedented and historical first in Queensland, Australia, the perioperative nurses were members of teams involved in the surgical separation of two sets of conjoined twins. Little is known about the (dis)stress that some of these perioperative nurses experienced nor how best to support them during such experiences. AIM: The aim of this paper is to report on the qualitative study that explored the experiences of those perioperative nurses involved in the surgical separation of cojoined twins and from their stories propose recommendations to support perioperative nurses who are confronted with such workplace experiences. METHODS: Using a narrative methodology, nine perioperative nurses shared their stories of being involved in the surgical separation of conjoined twins in Australia. Narrative and thematic analyses were conducted and recommendations to support perioperative nurses through workplace (dis)stress were identified. Participants validated the findings and recommendations. FINDINGS: The analyses revealed the themes of professionalism, teamwork, 'them vs. us' and emotional loads. DISCUSSION: The sensationalism around the rarity of conjoined twins brought an intensive intrusiveness from the world media. As a result, secrecy within the hospital about the conjoined twin cases created divisions between those perioperative nurses on the teams and those not. The processes and outcomes of the two surgical cases were in contrast to each other. For some perioperative nurses this caused distress. It is essential that professional support is offered in a way in which the perioperative nurse can take it up without fear of negative judgement.     

First trimester diagnosis of dicephalic parapagus conjoined twins via transvaginal ultrasonography

Conjoined twins are rare, and most cases are thoracopagus. Parapagus conjoined twins (one body with two heads) are extremely rare. We report a case of dicephalic parapagus twins that was diagnosed in the first trimester at 10 weeks via transvaginal ultrasonography.     

Assessment and management of conjoined twins

Although a rare anomaly, conjoined twins provide a unique challenge to the health care professional. At times, the ethical issues present difficult dilemmas for parents and hospital staff. An awareness of the moral dilemmas that tax the emotions of the most experienced hospital staff is the first step toward providing the appropriate support to these families. Nurses must have an understanding of the classification of conjoined twins and the preoperative and postoperative management. Additionally, awareness of the special needs of the family prior to discharge both before and after surgical separation allows for meeting comprehensive care needs. Although the process toward the separation of these twins can be complex, the overall outcome is rewarding.     

Prenatal sonographic diagnosis of cephalopagus conjoined twins at 14 weeks of pregnancy

Conjoined twins are extremely rare and are a type of monozygotic twins that occur due to an incomplete embryonic division on postconception day 13 to 15. Eight different types of conjoined twins have been described in the literature. Management of the condition depends on the site and extent of the union. We present a case of cephalopagus twins diagnosed at 14 weeks of gestation.     

Asymmetric parasitic dicephalus conjoined twins

In this report, we describe the case of a 19-year-old primigravida pregnant woman who had been hospitalized for 2 days with bleeding and a diagnosis of imminent abortion. Sonographic examination revealed a single fetus of approximately 17 weeks' gestation that initially appeared normal except for a mass on its neck. Further evaluation of the mass identified it as an anencephalic fetal head that was joined to the body with deformed cervical vertebrae. We diagnosed asymmetric parasitic dicephalus conjoined twins. The parents elected to terminate the pregnancy. Labor was induced, and the patient delivered a 20-cm, 208-g male fetus. The fetus had 4 normal limbs and a normal abdomen. Both its heads had a cleft lip, and its spine was U shaped with closed spina bifida at the spinal union in the thoracolumbar area. The patterns of conjoined twins are infinitely varied, but they can be generally classified according to standardized terms based on the anatomic site of their union. Cases of conjoined twins occur so rarely that it is important to learn as much as possible from each case.     

The antepartum findings of conjoined twins.

Various estimates abound as to the incidence of conjoined (Siamese) twins, but they are indeed uncommon. The probability of their occurance has been calculated to be once in every 12,000 to once in every 100,000 deliveries. Although uncommon, the antepartum diagnosis can be extremely important to the twins and the mother, if only to spare the trauma of a trial by labor. The findings, both radiographic and ultrasonic, are presented herein.