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Conjoined twins – role of imaging and recent advances

Rishi Philip Mathew1, Swati Francis2, Ram Shenoy Basti1, Hadihally B. Suresh1, Annie Rajarathnam2, Prema D. Cunha3, Sujaya V. Rao3

Affiliation and address for correspondence
J Ultrason 2017; 17: 259–266
DOI: 10.15557/JoU.2017.0038
Abstract

Introduction: Conjoined twins are identical twins with fused bodies, joined in utero. They are rare complications of monochorionic twinning. The purpose of this study is to describe the various types of conjoined twins, the role of imaging and recent advances aiding in their management. Material and methods: This was a twin institutional study involving 3 cases of conjoined twins diagnosed over a period of 6 years from 2010 to 2015. All the 3 cases were identified antenatally by ultrasound. Only one case was further evaluated by MRI. Results: Three cases of conjoined twins (cephalopagus, thoracopagus and omphalopagus) were accurately diagnosed on antenatal ultrasound. After detailed counseling of the parents and obtaining written consent, all the three cases of pregnancy were terminated. Delivery of the viable conjoined twins was achieved without any complications to the mothers, and all the three conjoined twins died after a few minutes. Conclusion: Ultrasound enables an early and accurate diagnosis of conjoined twins, which is vital for obstetric management. MRI is reserved for better tissue characterization. Termination of pregnancy when opted, should be done at an early stage as later stages are fraught with problems. Recent advances, such as 3D printing, may aid in surgical pre-planning, thereby enabling successful surgical separation of conjoined twins.

Keywords
cephalopagus, conjoined twins, omphalopagus, thoracopagus, 3D printing