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Ultraschall Med 2006; 27(4): 384-388
DOI: 10.1055/s-2005-858357
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Early Diagnosis of Conjoined Twins by Real-Time Three-Dimensional Ultrasound - Case Report and Review of the Literature

Frühe Diagnosestellung siamesischer Zwillinge unter Zuhilfenahme des Real-Time-3D-Ultraschalls - ein Fallbericht und LiteraturübersichtO. Schmid1 , A. Hagen1 , N. Sarioglu2 , H. Hopp1 , M. Entezami1, 3 , M. Albig3 , R. Becker1, 3
  • 1Charité - Campus Benjamin Franklin, Department of Obstetrics and Gynecology, Berlin, Germany
  • 2Charité - Campus Rudolf Virchow, Department of Paidopathology, Berlin, Germany
  • 3Center of Prenatal Diagnosis Berlin, Germany
Further Information

Publication History

eingereicht: 18.10.2004

angenommen: 23.3.2005

Publication Date:
13 April 2006 (online)

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Zusammenfassung

Kommt es mehr als 13 Tage nach der Befruchtung zur Trennung der Embryonalanlage, so geschieht dies unvollständig und es entstehen daraus siamesische Zwillinge. Dies kommt einmal auf 50 000 bis 100 000 Geburten vor [1] [2]. Wir berichten über den Fall eines Kraniothorakopagus, eine sehr seltene Form der siamesischen Zwillinge, der mit 13 Schwangerschaftswochen diagnostiziert wurde. Die 3D- und Real-Time-3-D-Sonographie sowie der Farb-Doppler-Ultraschall ermöglichten eine genaue Darstellung der Verschmelzung von Kopf und Rumpf bis hin zum Nabel sowie der fetalen Herzen. Beide fetalen Herzen verband ein arterio-arterieller Shunt. Ferner waren jeweils zwei Paare der oberen und unteren Extremitäten zu sehen. Nach einer eindeutigen Darstellung der Anomalie im 3D- und Real-Time-3-D-Modus entschied sich die Patientin, aufgrund der erkennbar schlechten Prognose zur Beendigung der Schwangerschaft. Die Obduktion bestätigte die pränatale Diagnose.

Abstract

In 1:50 000 to 1:100 000 births, conjoined twins occur, caused by incomplete division of the embryonic disc more than 13 days after fertilisation [1] [2]. We present a case of cephalothoracopagus janiceps, a very rare form of conjoined twins, which was diagnosed at 13 weeks of gestation. Three-dimensional and colour Doppler ultrasound enabled precise prenatal visualisation of the fusion of the foetal head and chest up to the umbilicus. We could demonstrate the presence of two foetal hearts connected by an arterio-arterial shunt as well as two pairs of upper and lower extremities. After the clear 3-D presentation of the anomaly, making the poor prognosis visible, the mother decided to have the pregnancy terminated. Autopsy confirmed the prenatal diagnosis.

Schlüsselwörter

Pränatale Diagnose - siamesische Zwillinge - 3D-Ultraschall - Zephalothorakopagus Janiceps

Key words

Prenatal diagnosis - conjoined twins - three-dimensional ultrasound - cephalothoracopagus janiceps

References

  • 1 Rudolph A J, Michaels J P, Nichols B L. Obstetric management of conjoined twins.  Birth Defects. 1967;  3 28-37
    PubMedSearch in Google Scholar
  • 2 Barth R A, Filly R A, Goldberg J D. et al . Conjoined twins: prenatal diagnosis and assessment of associated malformations.  Radiology. 1990;  177 201-207
    PubMedSearch in Google Scholar
  • 3 Edmonds L D, Layde P M. Conjoined twins in the United States 1970 - 1977.  Teratology. 1982;  25 301-308
    CrossrefPubMedSearch in Google Scholar
  • 4 Bland K G, Hammar B. Xiphopagus twins.  Cent Afr J Med. 1962;  8 371
    PubMedSearch in Google Scholar
  • 5 Bhettay E, Nelson M S, Beighton P. Epidemic of conjoined twins in southern Africa.  Lancet. 1975;  2 741-743
    PubMedSearch in Google Scholar
  • 6 Métneki J, Czeizel A. Conjoined twins in Hungary, 1970 - 1986.  Acta Genet Med Gemellol. 1989;  38 285-299
    PubMedSearch in Google Scholar
  • 7 Wilson R L, Cetrulo C L, Shaub M S. The prepartum diagnosis of conjoined twins by the use of diagnostic ultrasound.  Am J Obstet Gynecol. 1976;  126 (6) 737
    PubMedSearch in Google Scholar
  • 8 Lam Y H, Sin S Y, Lam C. et al . Prenatal sonographic diagnosis of conjoined twins in the first trimester: two case reports.  Ultrasound Obstet Gyneco. 1998;  11 289-291
    PubMedSearch in Google Scholar
  • 9 Iroku R O, Anah M. Triplets with conjoined twins. A Nigerian midwife’s case report.  J nurse-midwifery. 1990;  35 (2) 107-109
    PubMedSearch in Google Scholar
  • 10 Hoyle R M. Surgical separation of conjoined twins.  Surg Gynecol Obstet. 1990;  170 549-562
    PubMedSearch in Google Scholar
  • 11 Métneki J, Czeizel A. Conjoined twins in Hungary, 1970 - 1986.  Acta Genet Med Gemellol. 1989;  38 285-299
    PubMedSearch in Google Scholar
  • 12 Apuzzio J J, Ganesh V, Landau I. et al . Prenatal diagnosis of conjoined twins.  Am J Obstet Gynecol. 1984;  148 343-344
    PubMedSearch in Google Scholar
  • 13 Benirschke K, Kim C K. Multiple pregnancy.  N Engl J Med. 1973;  288 1329-1336
    PubMedSearch in Google Scholar
  • 14 Aird I. The conjoined twins of Kano.  Br Med J. 1954;  2 831-837
    PubMedSearch in Google Scholar
  • 15 Luckhardt A B. Report of autopsy of the siamese twins together with other interesting information covering their life; A sketch oh the life of Chang and Eng.  Surg Gynecol Obstet. 1941;  72 116-155
    PubMedSearch in Google Scholar
  • 16 Spencer R. Anatomic description of conjoined twins: a plea for standardized terminology.  J Pediatr Surg. 1996;  31 941-944
    CrossrefPubMedSearch in Google Scholar
  • 17 Nichols B L, Blattner R J, Rudolph A J. General clinical management of thoracopagus twins.  Birth Defects. 1967;  3 38
    PubMedSearch in Google Scholar
  • 18 Apuzzio J J, Ganesh V, Chervenak J. et al . Prenatal diagnosis of dicephalous conjoined twins in a triplet pregnancy.  Am J Obstet Gynecol. 1988;  159 1214-1215
    PubMedSearch in Google Scholar
  • 19 Boulot P, Deschamps F, Hedon B. et al . Conjoined twins associated with a normal singleton: very early diagnosis and successful selective termination.  J Perinat Med. 1992;  20 135-137
    PubMedSearch in Google Scholar
  • 20 Fagan C J. Antepartum diagnosis of conjoined twins by ultrasonography.  Am J Roentgenol. 1977;  129 921-922
    PubMedSearch in Google Scholar
  • 21 Kuroda K, Kamei Y, Kozuma S. et al . Prenatal evaluation of cephalopagus conjoined twins by means of three-dimensional ultrasound at 13 weeks of pregnancy.  Ultrasound Obstet Gynecol. 2000;  16 264-266
    PubMedSearch in Google Scholar
  • 22 Biswas A, Chia D, Wong Y C. Three-dimensional sonographic diagnosis of cephalothoracophagus janiceps twins at 13 weeks (Letter).  Ultrasound Obstet Gynecol. 2001;  18 289-290
    PubMedSearch in Google Scholar
  • 23 Bega G, Wapner R, Lev-Toaff A. et al . Diagnosis of conjoined twins at 10 weeks using three-dimensional ultrasound.  Ultrasound Obstet Gynecol. 2000;  16 388-390
    PubMedSearch in Google Scholar
  • 24 Cuillier F, Lemaire P, Sommer J C. et al . Prenatal diagnosis of omphalopagus conjoined twins at 13 weeks of amenorrhea.  Gynecol Obstet Fertil (France). 2001;  29 (5) 377-380
    CrossrefPubMedSearch in Google Scholar
  • 25 Daskalakis G, Pilalis A, Tourikis I. et al . First trimester diagnosis of dicephalus conjoined twins.  Eur J Obstet Gynecol Reprod Biol. 2004;  112 (1) 110-113
    CrossrefPubMedSearch in Google Scholar
  • 26 Scammon R E. Fetal malformations. Pedriatrics, vol 6. Philadelphia; WB Saunders 1925: 654
    Search in Google Scholar
  • 27 Hisano K, Nakamura K, Okada M. et al . Separation of conjoined twins using chest wall prosthesis.  J Pediat Surg. 1989;  24 928-929
    PubMedSearch in Google Scholar
  • 28 Harper R G, Kenigsberg K, Sia C G. et al . Xiphopagus conjoined twins: a 300 year review of the obstetric, morphopathologic, neonatal and surgical parameters.  Am J Obstet Gynecol. 1980;  137 617-629
    PubMedSearch in Google Scholar

Dr. Oliver Schmid

Charité - Campus Benjamin Franklin, Department of Obstetrics and Gynecology, Hindenburgdamm 30

12200 Berlin, Germany

Phone: ++ 49/30/84 45 24 54

Fax: ++ 49/30/84 45 44 77

Email: oliver.schmid@charite.de