Monochorionic triplet pregnancy complicated by conjoined twins and early twin–twin transfusion syndrome

IF 1.6 4区医学 Q4 DEVELOPMENTAL BIOLOGY Birth Defects Research Pub Date : 2024-02-16 DOI:10.1002/bdr2.2317

Juan Carlos Bustos, Helga Vera, Paz Ahumada, Daniel Martin

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Abstract

Background

The condition of monozygotic, monochorionic triplet fetuses with a pair of conjoined twins is extremely rare (close to one in a million births), presents challenges in its management, and with poor prognosis.

Case report

We report a case of monochorionic diamniotic triplet pregnancy, ultrasound at 14 weeks shows a pair of conjoined thoracopagus fetuses, sharing heart, liver, and umbilical cord, in addition to omphalocele. The third fetus, without malformations, presents signs of early heart failure compatible with twin-to-twin transfusion syndrome. It was decided to carry out expectant management where at 18 weeks, intrauterine death of the three fetuses occurs. An abortion is performed by hysterotomy.

Conclusions

The treatment in these cases is discussed, three management options have been proposed: expectant management, selective reduction of the conjoined fetuses, or termination of the pregnancy. A review of the literature found only 12 cases with this combination of pathologies, in which only 3 normal fetuses (25%) survived and none of the conjoined twins survived. To our knowledge, this case is the first of a monochorionic triplet pregnancy with conjoined fetuses complicated with early twin-to-twin transfusion.

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单绒毛膜三胞胎妊娠并发连体双胞胎和早期双胞胎输血综合征。

背景：单卵双胎、单绒毛膜三胞胎和一对连体婴儿的情况极为罕见（接近百万分之一），其管理面临挑战，且预后较差：我们报告了一例单绒毛膜双羊膜腔三胎妊娠，14 周时的超声检查显示一对连体胸腔畸形胎儿，共用心脏、肝脏和脐带，此外还有脐膨出。第三个胎儿没有畸形，但出现了早期心衰的迹象，与双胎输血综合征相符。在 18 周时，三个胎儿在宫内死亡。结论：讨论了这些病例的治疗方法：对这些病例的治疗方法进行了讨论，提出了三种处理方案：期待处理、选择性减少连体胎儿或终止妊娠。查阅文献后发现，只有 12 例合并这种病变的病例，其中只有 3 个正常胎儿（25%）存活，连体婴儿无一存活。据我们所知，本病例是首例单绒毛膜三胞胎妊娠合并连体胎儿早期双胎输血的病例。

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来源期刊

Birth Defects Research Medicine-Embryology

CiteScore

3.60

自引率

9.50%

发文量

153

期刊介绍： The journal Birth Defects Research publishes original research and reviews in areas related to the etiology of adverse developmental and reproductive outcome. In particular the journal is devoted to the publication of original scientific research that contributes to the understanding of the biology of embryonic development and the prenatal causative factors and mechanisms leading to adverse pregnancy outcomes, namely structural and functional birth defects, pregnancy loss, postnatal functional defects in the human population, and to the identification of prenatal factors and biological mechanisms that reduce these risks. Adverse reproductive and developmental outcomes may have genetic, environmental, nutritional or epigenetic causes. Accordingly, the journal Birth Defects Research takes an integrated, multidisciplinary approach in its organization and publication strategy. The journal Birth Defects Research contains separate sections for clinical and molecular teratology, developmental and reproductive toxicology, and reviews in developmental biology to acknowledge and accommodate the integrative nature of research in this field. Each section has a dedicated editor who is a leader in his/her field and who has full editorial authority in his/her area.