Abstract
BackgroundAsymmetric and parasitic conjoined twins are rarer anomalies of monochorionic monoamniotic twins, consisting of an incomplete twin attached to the fully developed body of the co-twin.Case presentationA 30-year-old multigravid woman referred to maternal fetal unit due to polyhydramnios at 28th week of gestation. Sonographic examination revealed a single fetus and polyhydramnios with amniotic fluid index 30 cm. The fetus had normal apparent single head, spine, thorax, abdomen, two upper and two lower limbs, and two relatively well developed rudimentary parasitic lower limbs at sacral region. Lower limbs of the autosite were moving freelly but no movement was detected at the parasite. The parasite contained irregular lower limbs and left foot with three toes. Short and deformed long bones were also present in the parasitic limbs. A Cesarean section was performed at 38th week of gestation and a live female infant weighing 3600 g was delivered. The parasitic lower limbs were totally excised. Post-operative period was uneventful and the newborn was discharged as healthy. Post-natal follow-up was normal at nine-month-old.ConclusionPygopagus tetrapus parasitic twin is a rare form of conjoined twins and in utero diagnosis with ultrasound assists in prenatal management and counselling with parents.
Highlights
Asymmetric and parasitic conjoined twins are rarer anomalies of monochorionic monoamniotic twins, consisting of an incomplete twin attached to the fully developed body of the co-twin.Case presentation: A 30-year-old multigravid woman referred to maternal fetal unit due to polyhydramnios at 28th week of gestation
We report a case of pygopagus tetrapus parasitic twin diagnosed at 28th week of gestation and delivered a live baby at term
The infant was further evaluated with US and magnetic resonance imaging (MRI) that confirmed that parasitic conjoined twin had no relation with the spinal cord or related structures
Summary
With an estimated frequency of one in 50,000–100,000 births [1]. Parasitic conjoined twin diagnosed in utero was presented in few cases previously [7,8]. We report a case of pygopagus tetrapus parasitic twin diagnosed at 28th week of gestation and delivered a live baby at term. The woman had no family history of congenital anomalies and had taken no medication during her pregnancy Her obstetric background consisted of two first trimester abortions and a healthy live birth at term. The infant appeared to be normal except the parasitic co-twin (Figure 3 and Figure 4). The infant was further evaluated with US and MRI that confirmed that parasitic conjoined twin had no relation with the spinal cord or related structures. Two deformed lower limbs were attached to the sacral mass. After dissection of the mass and the parasitic limbs, long bones of bilateral lower limbs and some pelvic bone were seen
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