Early separation of parasitic conjoined twins at a tertiary care hospital: A case report

IF 0.2 Q4 PEDIATRICS
Ahmad Yani , Wulan Ayudyasari , Kshetra Rinaldhy , Muhamad Luthfi Prasetyo , Nafissa Amanda Safinati Yani
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Abstract

Introduction

Conjoined twins is defined as twins that are physically fused in utero and at birth. Parasitic conjoined twins is a particularly rare form of conjoined twins, occurring in fewer than 1 in 1 million live births. The management of parasitic conjoined twins remains a challenge, lacking a universal consensus regarding the optimal timing for separation surgery.

Case presentation

A 31-week pregnant woman presented with a fetal emergency. Ultrasound at 27 weeks revealed conjoined abdominopagus twins sharing a single liver. At 31 weeks, only one fetal heartbeat was detected, requiring an urgent cesarean section. Two asymmetric female twins were delivered: Neonate A, who survived with an APGAR score of 7/9, and Neonate B, a stillbirth. Neonate A had ventriculomegaly, while Neonate B exhibited multiple congenital anomalies, including bilateral cleft lip, hypodactyly, hydrocephalus, and hydrops fetalis. Neonate A was stabilized and underwent successful early separation surgery. Postoperatively, Neonate A received intensive care, including respiratory support, broad-spectrum antibiotics, and treatment for a patent ductus arteriosus. At one-month follow-up, Neonate A was stable and recovering well.

Conclusion

Early separation of parasitic conjoined twins is recommended in cases with one stillborn or deceased twin, as it improves survival chances for the autosite. Delayed separation is advised for cases with two viable twins, allowing for organ maturation and reducing intraoperative complications.
三级医院寄生虫连体婴早期分离一例
连体双胞胎被定义为在子宫内和出生时身体融合的双胞胎。寄生连体双胞胎是一种特别罕见的连体双胞胎,在100万活产婴儿中发生的几率不到1。寄生连体双胞胎的管理仍然是一个挑战,缺乏关于分离手术的最佳时机的普遍共识。一例31周妊娠妇女出现胎儿急症。27周的超声检查显示,连体腹腹双胞胎共用一个肝脏。在31周时,只检测到一次胎儿心跳,需要紧急剖宫产。出生了两个不对称的女性双胞胎:新生儿A,存活下来,APGAR评分为7/9,新生儿B,死产。新生儿A有脑室肿大,而新生儿B有多种先天性异常,包括双侧唇裂、趾下畸形、脑积水和胎儿积水。新生儿A病情稳定,并成功进行了早期分离手术。术后,新生儿A接受重症监护,包括呼吸支持、广谱抗生素和动脉导管未闭治疗。随访1个月,新生儿A病情稳定,恢复良好。结论寄生连体双胞胎中有一个胎死腹中或死亡时,建议尽早分离,以提高寄生连体双胞胎的生存机会。对于有两个存活的双胞胎的病例,建议延迟分离,允许器官成熟并减少术中并发症。
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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