Sepulveda W, Munoz H, Alcalde J L
Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile.
Ultrasound Obstet Gynecol. 2003 Aug;22(2):199-204. doi: 10.1002/uog.185.
We report two cases of conjoined twins complicating a triplet pregnancy diagnosed by two-dimensional ultrasound in the first trimester and evaluated further by three-dimensional ultrasound. A review of the literature over the last 30 years revealed 11 other cases diagnosed prenatally by ultrasound. Overall, three (23%) of these 13 pregnancies were achieved by assisted reproductive techniques and 10 (77%) were diagnosed before 18 weeks. Four women opted for termination of the whole pregnancy and three were managed expectantly, with two delivering before 32 weeks. Two monochorionic pregnancies underwent selective feticide with intrauterine demise of the non-conjoined fetus in both cases. All four dichorionic pregnancies undergoing selective termination or spontaneous embryo reduction to singleton in the first trimester resulted in term delivery of the non-conjoined fetus. The rare condition of conjoined twins in a triplet pregnancy poses a significant obstetric challenge from both diagnostic and management points of view. Accurate determination of chorionicity in these cases plays a critical role in determining management and outcome.
我们报告了两例三胎妊娠合并联体双胎的病例，这两例在孕早期通过二维超声诊断，并进一步通过三维超声评估。回顾过去30年的文献发现，另有11例联体双胎通过超声产前诊断。总体而言，这13例妊娠中有3例（23%）是通过辅助生殖技术实现的，10例（77%）在孕18周前确诊。4名女性选择终止整个妊娠，3名选择期待治疗，其中2名在孕32周前分娩。2例单绒毛膜双胎妊娠均进行了选择性减胎术，非联体胎儿均在宫内死亡。所有4例双绒毛膜双胎妊娠在孕早期进行选择性终止妊娠或自然减胎为单胎妊娠，均足月分娩了非联体胎儿。三胎妊娠合并联体双胎这种罕见情况，从诊断和管理角度来看都对产科构成了重大挑战。在这些病例中准确确定绒毛膜性对于确定管理方案和结局起着关键作用。
