Leigh Mariatu Binta, John-Cole Valerie, Kamara Mike, Koroma Alimamy Philip, Koroma Michael Momoh, Emuveyan Edward Ejiro, Bramlage Peter, Buschmann Ivo
Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone.
Center for Internal Medicine I, Department for Angiology, Medical School Brandenburg Theodor Fontane (MHB), Campus Brandenburg, Brandenburg, Germany.
Case Rep Obstet Gynecol. 2017;2017:6815748. doi: 10.1155/2017/6815748. Epub 2017 Dec 5.
Conjoined twins are very rarely seen. We present a case of thoracopagus that was undiagnosed prior to delivery and combined with eclampsia and obstructed labor in a low-resource setting in sub-Saharan Africa. A 27-year-old pregnant woman was presented to the maternity emergency unit of Princess Christian Maternity Hospital (PCMH) in Freetown at term in labor. Upon admission, the patient was awake and orientated and presented a blood pressure of 180/120 mmHg and a protein value of 3+ on urine dipstick test. Clinical examination-ultrasound was not available-led to the admission diagnosis: obstructed labor with intrauterine fetal death and preeclampsia. Application of Hydralazine 5 mg (i.v.) under close blood pressure monitoring was performed. Under spontaneous progression of labor, one head of the yet unknown conjoined twin was born. The patient developed eclamptic fits. Ceasing of seizures was achieved after implementing the loading dose of the MgSO protocol. A vaginal examination led to the unexpected diagnosis of conjoined twins. An emergency cesarean section under general anesthesia via a longitudinal midline incision was performed immediately. The born head was repositioned vaginally. The stillborn conjoined twins presented a female thoracopagus type that seemed to involve the heart. After 8 weeks, the woman was clinically fully recovered.
联体双胎极为罕见。我们报告一例胸部联体双胎病例，该病例在分娩前未被诊断出来，且发生在撒哈拉以南非洲资源匮乏地区，同时合并子痫和产程梗阻。一名27岁的孕妇足月临产时被送往弗里敦公主基督教妇产医院（PCMH）的产科急诊室。入院时，患者神志清醒、定向力正常，血压为180/120 mmHg，尿试纸检测蛋白值为3+。由于无法进行临床检查 - 超声，入院诊断为：产程梗阻伴宫内胎儿死亡和先兆子痫。在密切监测血压的情况下静脉注射5毫克肼屈嗪。在产程自然进展过程中，联体双胎中一个尚未知晓的头部娩出。患者出现子痫发作。在实施硫酸镁方案的负荷剂量后惊厥停止。阴道检查意外诊断出联体双胎。立即在全身麻醉下经纵向中线切口进行急诊剖宫产。已娩出的头部经阴道复位。死产的联体双胎为女性胸部联体类型，似乎累及心脏。8周后，该名女性临床完全康复。
