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Diagnosis and Management of Conjoined Twins

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Twin and Higher-order Pregnancies

Abstract

Conjoined twins (CT) are a rare complication of monoamniotic twinning. The true incidence of this complication is difficult to estimate because most women with the diagnosis either choose not to continue the pregnancy or an intrauterine demise ensues. For continuing pregnancies, prognosis is mostly determined by the site fusion and the organs involved. Ultrasound, 3D ultrasound, and magnetic resonance imaging are critical for antenatal diagnosis, careful analysis of the area of fusion, and subsequent prognostication. Only a minority of twins that survive birth will go on to be candidates for surgical separation. Surgical separation should only be attempted at centers with expertise in these procedures, which are complex and frequently associated with residual morbidity. Because the ethical considerations of surgical separation are complex, a palliative care team is critical for understanding patient and her family’s goals and preferences.

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Key Reading

  • Brizot ML, Liao AW, Lopes LM, et al. Conjoined twins pregnancies: experience with 36 cases from a single center. Prenat Diagn. 2011;31(12):1120–5.

    CAS  PubMed  Google Scholar 

  • Martinez-Frias ML, Bermejo E, Mendioroz J, et al. Epidemiological and clinical analysis of a consecutive series of conjoined twins in Spain. J Pediatr Surg. 2009;44(4):811–20.

    Article  PubMed  Google Scholar 

  • Mathew RP, Francis S, Basti RS, et al. Conjoined twins – role of imaging and recent advances. J Ultrason. 2017;17(71):259–66.

    Article  PubMed  PubMed Central  Google Scholar 

  • Votteler TP, Lipsky K. Long-term results of 10 conjoined twin separations. J Pediatr Surg. 2005;40(4):618–29.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center, Houston, Houston, TX, USA

    Clifton Brock & Anthony Johnson

  2. The Fetal Center at Children’s Memorial Hermann Hospital, Houston, TX, USA

    Clifton Brock & Anthony Johnson

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  1. Clifton Brock
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  2. Anthony Johnson
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Correspondence to Anthony Johnson .

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Editors and Affiliations

  1. Fetal Medicine Unit, St George’s University Hospitals, NHS Foundation Trust, London, UK

    Asma Khalil

  2. Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium

    Liesbeth Lewi

  3. Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands

    Enrico Lopriore

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Brock, C., Johnson, A. (2021). Diagnosis and Management of Conjoined Twins. In: Khalil, A., Lewi, L., Lopriore, E. (eds) Twin and Higher-order Pregnancies. Springer, Cham. https://doi.org/10.1007/978-3-030-47652-6_19

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