Conjoined twins pregnancies: experience with 36 cases from a single center
M L Brizot1, A W Liao, L M Lopes
1Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, SP, Brazil. mlbrizot@uol.com.br
Objective:
To review a single center's experience in the management of twin pregnancies with conjoined fetuses.
Methods:
Retrospective study describing prenatal findings, delivery details, surgical treatment and perinatal outcome.
Results:
The study included 36 twin pregnancies with conjoined twins seen over a period of 12 years in a single tertiary hospital: 69.4% were thoracopagus, 13.9% parapagus, 8.3% omphaloischiopagus 5.6% omphalopagus and 2.8% cephalopagus. Cardiac defects were present in 91.6% of twin pairs and associated malformations were present in 61.8% of the cases: limb abnormalities in 36.1%, abdominal wall defects in 25.0%, cleft lip and/or palate in 13.9% and congenital diaphragmatic hernia in 5.5%. Surgical separation was considered not feasible and prognosis lethal in 30 (83.3%) cases. Termination of pregnancy was performed in 12 pregnancies of poor prognosis. Cesarean section was performed in all remaining cases. Five sets of twins underwent surgical separation and six children survived. Overall survival in our series was 8.3% and, among the livebirths, 13.6%.
Conclusion:
Conjoined twin pregnancies should be referred to tertiary centers for detailed fetal anomaly and echocardiographic assessment to evaluate prognosis and determine the possibility of postnatal surgical separation.
