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Cephalothoracoomphalopagus: a rare type of conjoined twin.
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PMID:  24741542     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
We present a case of female cephalothoracoomphalopagus conjoind twin, which is extremely rare type of conjoined twins. We also review the contemprory knowledge regarding incidence, etiopathogenesis, antenatal diagnosis and outcone or the prognosis of conjoint twins. The case belong to hindu female, no history of consanguineous marriage, ingestion of drugs or exposure to any radiation. History of one abortion and one twin delivery present. Conjoind twin was cephalothoracoomphalopagus type, delivered vaginaly at 30 wks of gestion to a 25 yrs old multigravida. Management of conjoind twin still remain challenges because of multiple congenital anomalies and poor outcome is seen.
Authors:
Sunita Koreti; Nitin Prasad; G Singh Patell
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical neonatology     Volume:  3     ISSN:  2249-4847     ISO Abbreviation:  J Clin Neonatol     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-04-17     Completed Date:  2014-04-17     Revised Date:  2014-04-21    
Medline Journal Info:
Nlm Unique ID:  101605525     Medline TA:  J Clin Neonatol     Country:  India    
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Languages:  eng     Pagination:  47-8     Citation Subset:  -    
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Journal Information
Journal ID (nlm-ta): J Clin Neonatol
Journal ID (iso-abbrev): J Clin Neonatol
Journal ID (publisher-id): JCN
ISSN: 2249-4847
ISSN: 1658-6093
Publisher: Medknow Publications & Media Pvt Ltd, India
Article Information
Copyright: © Journal of Clinical Neonatology
open-access:
Print publication date: Season: Jan-Mar Year: 2014
Volume: 3 Issue: 1
First Page: 47 Last Page: 48
PubMed Id: 24741542
ID: 3982341
Publisher Id: JCN-3-47
DOI: 10.4103/2249-4847.128737

Cephalothoracoomphalopagus: A Rare Type of Conjoined Twin
Sunita Koretiaff1
Nitin Prasad1
G. Singh Patellaff1
Department of Pediatrics, G. R. Medical College, Gwalior, Madhya Pradesh, India
1S.S.Medical College, Rewa Madhya Pradesh, India
Correspondence: Address for correspondence: Dr. Sunita Koreti, S-14A, Sarika Nagar, Darpan Colony, Behind BVM College, Gwalior, Madhya Pradesh, India. E-mail: drsunitaprasad@yahoo.in

INTRODUCTION

Twin who share their vital organ and body parts, are referred as conjoined twin. Types - cephalopagus-fusion from top of the head to umbilicus, thoracopagus - united from upper thorax down to the umbilicus. Omphalopagus-fetuses are joined primarily in the area of umbilicus. Craniopagus-united on any portion of skull except face. Rare types - cephalo thoracopagus, cephalo thoraco omphalopagus,[1, 2] etiopathogenesis.

The precise etiology of conjoined twinning is unknown. The most common explanation is fission of single zygot, or alternatively fusion of two dizygotic or monozygotic embryos in their very early embryonic development between 13 and 15 days after conception. Because conjoined twins develop after differentiation of the chorion and amnion all conjoined twins are monochorionic-monoamniotic.[3, 4]


CASE REPORT

This was a case report of a 25-year-old, multigravid women (gravid 3, para 2, abortion 1) who was admitted in Department of Obstetrics and Gynecology with labor pain at 30 weeks of gestation. History of previous preterm twin delivery present, twins died after delivery. There was no history of exposure to teratogenic agent in pregnancy, she has not gone for any antenatal checkup anywhere, or ultrasonography evaluation before admission to our hospital. Vaginal delivery was performed. Conjoined twins were born with apgar score 1, weighing 1.08 kg. Baby was immediately shifted to Sick Newborn Care Unit of Department of Pediatrics.

On examination, it was seen that the twins were joined from the head down to thorax with one head, one face, one neck, a single thorax and abdomen, and a single umbilical cord. On the face there were two eyes, one nose and two ears. On the thorax, at the front and back, there existing total four nipples, being two on either side and there were four upper limbs and single spine [Figures 1 and 2]. They were separate from pelvis with four lower limbs and two female genitals. On cardiac examination apex was localized to single left site, on per abdomen examination single liver was palpable they were rare type of conjoined twins-cephalothoraco omphalopagus.

There was no improvement after all intensive care management and the conjoined twin died after 20 min following delivery.


DISCUSSION

The exact frequency of conjoined twins is not established and estimated incidence varies in the literatures. Spontaneous twinning occurs in 1.6% of all human pregnancies, of which 1.2% are dizzygotic and. 4% are monozygotis. In India and africa1:14,000 birth and in Europe 1:250,000 live birth has been estimated, suggesting an increase incidence in black population in addition to this conjoined twins are 3 times more common in female fetuses than male, but its incidence dose not vary with maternal age, parity. If we see the incidence of various types-thoraco omphalopagus (28%), thoracopagus (18.5%), omphalopagus (10%), craniopagus (6%). Cephalopagus (5%) while cephalo thoracopagus and cephalo thoraco omphalopagus are extremely rare.[4, 5, 6]

Prognosis is very poor among conjoined twins. In a study of 14 cases of prenatally diagnosed conjoined twins, 28% of cases died in utero, 54% died immediately after birth, and only 18% survived out of which 50% died postoperatively.[4, 6, 7] In another study the prognosis was unfavorable, with approximately 40% of cases stillborn The prognosis of cephalo thoracopagus is extremely poor because single brain and heart are present with fused gastrointestinal tracts.[4, 7]


Notes

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES
1. Vural F,Vural B. First trimester diagnosis of dicephalic parapagus conjoined twins via transvaginal ultrasonographyJ Clin UltrasoundYear: 200533364616196006
2. Turgut F,Turgut M,Başaloglu H,Başaloglu HK,Haberal A. Extremely rare type of conjoined twins: Cephalothoracopagus deradelphusEur J Obstet Gynecol Reprod BiolYear: 19988019149846666
3. Graham GM 3rd,Gaddipati S. Diagnosis and management of obstetrical complications unique to multiple gestationsSemin PerinatolYear: 2005292829516360487
4. Stone JL,Goodrich JT. The craniopagus malformation: Classification and implications for surgical separationBrainYear: 200612910849516597654
5. Turgurt F,Turgut M,Basaluglu HK. HABERAL A: Extremely rare type of conjoined twins cephalothoracopagus deradelphusEur J Obstet Gyn R BYear: 199880191
6. Graham GM 3rd,Ghaddipati S. Diagnosis and management of obstetric complications unique tomultiple gestationSemin PerinatolYear: 20052928229516360487
7. Hill LM. The sonographic detection oh early first trimester conjoined twinsPrenat DiagnYear: 19971796139358576

Figures

[Figure ID: F1]
Figure 1 

(Anterior view) Single head, face, neck, thorax and abdomen with single umblicus and seperate upper, lower limbs with seperate pelvis and genitals



[Figure ID: F2]
Figure 2 

(Posterior view) Two vertebral column with seperate sets of upper and lower limbs



Article Categories:
  • Case Report

Keywords: Cephalothoracoomphalopagus, conjoind twin, outcome.

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