ultrasound diagnosis of fatal anomalies

MULTIPLE PREGNANCY
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cesarean section is indicated for the benefit of
both the mother and the twins.
Procedure after birth: Immediate care of the
neonates can prove to be extremely difficult, especially
if respiratory distress is present. Cardiac
massage is impossible in thoracopagus twins.
Surgical intervention is more successful if there
is sufficient time for optimal preparation and if it
can be performed at a much later stage, rather
than in the immediate neonatal period. The
main aim of the operation is to separate the
twins.
Prognosis: This depends on the location and
length of fusion. The prognosis also depends on
the presence of vital organs such as the liver and
heart in both twins. If surgical separation is absolutely
necessary in the first 3 weeks after birth,
there is a high mortality rate of almost 50%. Surgical
separation performed between 4 and
14 weeks after birth has a 90% survival rate.
Self-Help Organization
Title: Conjoined Twins International
Description: Support for conjoined twins,
their families, and professionals. Offers peer
support, professional counseling, crisis intervention,
telephone helpline, pen-pal network,
videos. Information and referrals. Peer counseling
speakers bureau. Registry of affected
families. Quarterly newsletter. Membership
directory.
Scope: International network
Founded: 1996
Address: P.O. Box 10895, Prescott, AZ 86304–
0895, United States
Telephone: 520–445–2777
Twin Reversed Arterial Perfusion (TRAP sequence)
Definition: This is a complex malformation arising
exclusively in monochorionic twins. In this
case, a rudimentary twin, without head
(acranius) or heart (acardius), is being provided
by the healthy second twin.
Incidence: One in 35 000 births; about one in 150
monozygotic twins.
References
Barth RA, Filly RA, Goldberg JD, Moore P, Silverman NH.
Conjoined twins: prenatal diagnosis and assessment
of associated malformations [published erratum appears
in Radiology 1991; 178: 287]. Radiology 1990;
177: 201–7.
Cazeneuve C, Nihoul FEC, Adafer M, et al. Conjoined omphalopagous
twins separated at fifteen days of age.
Arch Pediatr 1995; 2: 452–5.
Chatterjee MS, Weiss RR, Verma UL, Tejani NA, Macri J.
Prenatal diagnosis of conjoined twins. Prenat Diagn
1983;3:357–61.
De Ugarte DA, Boechat MI, ShawWW, Laks H, Williams
H, Atkinson JB. Parasitic omphalopagus complicated
by omphalocele and congenital heart disease. J Pediatr
Surg 2002; 37: 1357–8.
Hubinont C, Kollmann P, Malvaux V, Donnez J, Bernard P.
First-trimester diagnosis of conjoined twins. Fetal
Diagn Ther 1997; 12: 185–7.
Intödy Z, Pálffy I, Hajdu K, Hajdu Z, Török M, Laszlo J.
Prenatal diagnosis of thoracopagus in the 19th week
of pregnancy. Zentralbl Gynäkol 1986; 108: 57–61.
Karsdorp VH, van den Linden JC, Sobotka PM, Prins H,
van den Harten JJ, van VugtJM. Ultrasonographic prenatal
diagnosis of conjoined thoracopagus twins: a
case report. Eur J Obstet Gynecol Reprod Biol 1991;
39: 157–61.
Skupski DW, Streltzoff J, Hutson JM, Rosenwaks Z,
Cohen J, Chervenak FA. Early diagnosis of conjoined
twins in triplet pregnancy after in vitro fertilization
and assisted hatching. J Ultrasound Med 1995; 14:
611–5.
Spitz L, Kiely EM. Experience in the management of conjoined
twins. Br J Surg 2002; 89: 1188–92.
Weingast GR, Johnson ML, Pretorius DH, et al. Difficulty
in sonographic diagnosis of cephalothoracopagus.
Ultrasound Med 1984; 3: 42–3.
Wenzl R, Schurz B, Amann G, Eppel W, Schon HJ, Reinolc
E. Diagnosis of cephalothoracopagus: a case report.
Ultraschall Med 1992; 13: 199–201.
Laboratory parameters: Alpha fetoprotein is elevated
in serum and in amniotic fluid. Acetylcholinesterase
test results are positive in amniotic
fluid.
Embryology: This probably arises due to vessel
anastomoses between monozygotic twins
within the placenta. The communicating vessels
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