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

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

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