ABSTRACT
Presentamos un caso de embarazo gemelar, monocorial-bianmiotico con discrepancias morfológicas, diagnóstico de malformación y obstrucción uretral prenatal y diagnóstico postnatal de Síndrome de Prune-Belly. Feto A: Dilatación macroscópica del sistema colector con vejiga grande con paredes finas, hidroureter bilateral , dilatación de la uretra, parenquima renal aumentado de tamaño. Feto B: sin alteraciones morfológicas. Postnatal se observó en feto A abdomen flácido y pastoso, ano imperforado, megavejiga e insuficiencia renal
We present a case of twin pregnancy, monocorial-bi-mixtic with morphological discrepancies, diagnosis of malformation and prenatal urethral obstruction and postnatal diagnosis of Prune-Belly syndrome. Fetus A: Macroscopic dilation of the collecting system with large bladder with fine walls, bilateral hydroureter, dilation of the urethra, renal parenchymal increased in size. Fetus B: without morphological alterations. Postnatal was observed in fetus at flaccid and pasty abdomen, imperforated anus, megavejiga and renal failure.
Subject(s)
Humans , Female , Adult , Prune Belly Syndrome/pathology , Congenital Abnormalities/physiopathology , Pregnancy, High-Risk , Pregnancy, TwinABSTRACT
El embarazo gemelar en una de las cavidades uterinas del útero bicorpóreo es una rara presentación clínica. La viabilidad de este tipo de embarazo es de baja probabilidad, dado que esta malformación puede condicionar parto prematuro, placentación anormal, restricción del crecimiento fetal o progresión anormal del trabajo de parto. Se presenta un caso de un útero bicorpóreo con doble cérvix y una gestación gemelar en unas de las cavidades uterinas, con muerte fetal de uno de los fetos y parto pretérmino de 28 semanas del otro gemelo. Dada la rareza de la presentación se describen el caso y los hallazgos imagenológicos representativos.
Twin pregnancy in one of the uterine cavities of the bicoporous uterus is a rare clinical presentation. The viability of this type of pregnancy is unlikely since this malformation can lead to premature delivery, abnormal placentation, fetal growth restriction or abnormal progression of labor. We present a case of bicoporous uterus with double cervix with twin pregnancy in one of the uterine cavities, with stillbirth of one of the fetuses and preterm delivery of the other twin at 28 weeks. Given the rarity of the presentation, the case and representative imaging findings are described.
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy, Twin , Uterine Duplication Anomalies/diagnostic imaging , Uterus/diagnostic imaging , Pregnancy Outcome , Ultrasonography, Prenatal , Mullerian Ducts/abnormalities , Mullerian Ducts/diagnostic imagingABSTRACT
As interações sociais iniciais são fundamentais para o desenvolvimento infantil, sendo essencial o papel dos adultos na promoção de práticas que o favoreçam. Tais práticas podem ser influenciadas por aspectos contextuais e pelas emoções, concepções e expectativas parentais sobre seus filhos. No presente estudo, foi considerada a configuração familiar caracterizada pela presença de bebês gêmeos. O objetivo foi conhecer as emoções das mães acerca da gravidez gemelar e analisar as suas concepções e expectativas sobre o desenvolvimento dos gêmeos nos primeiros 24 meses de vida. Participaram deste estudo nove mães de bebês gemelares, que responderam a um questionário sociodemográfico e a uma entrevista semiestruturada. Os resultados revelaram sentimentos maternos ambivalentes relativos à experiência com a gemelaridade desde a gestação; concepções sobre desenvolvimento infantil, fatores que podem influenciá-lo e diferenças entre os gêmeos; e expectativas sobre o desenvolvimento dos bebês. Conclui-se que uma maior compreensão sobre aspectos relacionados à maternidade de gemelares pode auxiliar na criação de redes de apoio socioemocional aos cuidadores e de contextos que favoreçam as interações estabelecidas entre a tríade mãe-bebês.
Initial social interactions are fundamental to child development, and the role of adults in promoting practices that favor them is essential. Such practices can be influenced by contextual aspects and by parental emotions, conceptions and expectations about their children. In the present study, the family configuration characterized by the presence of twin babies was considered. The objective was to get to know the mothers' emotions about twin pregnancies and to analyze their conceptions and expectations about the development of twins in the first 24 months of life. Nine mothers of twin babies participated in this study, who answered a sociodemographic questionnaire and a semi-structured interview. The results revealed ambivalent maternal feelings regarding the experience with twinning since pregnancy; conceptions about child development, factors that can influence it and differences between twins; and expectations about the development of babies. We conclude that a greater understanding of aspects related to twin maternity can help in the creation of social and emotional support networks for caregivers and contexts that favor the interactions established between the mother-babies triad.
Las interacciones sociales iniciales son fundamentales para el desarrollo infantil, siendo fundamental el rol de los adultos en la promoción de prácticas que los favorezcan. Dichas prácticas pueden estar influenciadas por aspectos contextuales y por emociones, concepciones y expectativas de los padres sobre sus hijos. En el presente estudio se consideró la configuración familiar caracterizada por la presencia de bebés gemelos. El objetivo fue conocer las emociones de las madres sobre los embarazos gemelares y analizar sus concepciones y expectativas sobre el desarrollo de los gemelos en los primeros 24 meses de vida. En este estudio participaron nueve madres de gemelos, quienes respondieron un cuestionario sociodemográfico y una entrevista semiestructurada. Los resultados revelaron sentimientos maternos ambivalentes con respecto a la experiencia del hermanamiento desde el embarazo; concepciones sobre el desarrollo infantil, factores que pueden influir en él y diferencias entre gemelos; y expectativas sobre el desarrollo de los bebés. Concluimos que una mayor comprensión de los aspectos relacionados con la maternidad gemelar puede ayudar en la creación de redes de apoyo social y emocional a los cuidadores y contextos que favorezcan las interacciones que se establecen entre la tríada madre-bebé.
Subject(s)
Humans , Female , Pregnancy , Twins , Child Development , Parenting , Emotions , Pregnancy, Twin , Motivation , Perception , Personal Narrative , Mother-Child RelationsABSTRACT
La preeclampsia se puede asociar a una patología poco frecuente como es el hígado graso agudo del embarazo. Se reporta el caso clínico de una paciente de 35 años, tercigesta, cursando embarazo gemelar que presenta preeclampsia con elementos de gravedad, asociada a hígado graso agudo del embarazo. Se realiza diagnóstico y tratamiento precoz de ambas patologías, presentando buena evolución materno-fetal.
Preeclampsia can be associated with acute fatty liver of pregnancy, a rare disease. This report describes the case of a 35-year-old patient, gravida 3, pregnant with twins, who presented with severe pre-eclampsia associated with acute fatty liver of pregnancy. Early diagnosis and treatment of both pathologies was performed, resulting in good maternal-fetal evolution.
A pré-eclâmpsia pode estar associada a uma patologia rara, como o fígado gorduroso agudo da gravidez. Neste relato, apresentamos uma paciente de 35 anos, terciária, em gestação gemelar, apresentando pré-eclâmpsia grave, associada a esteatose hepática aguda na gestação. É realizado diagnóstico e tratamento precoces de ambas as patologias, apresentando boa evolução materno-fetal.
Subject(s)
Humans , Female , Pregnancy , Adult , Pre-Eclampsia/diagnosis , Fatty Liver/diagnosis , Pre-Eclampsia/therapy , Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Cesarean Section , Acute Disease , Hepatic Insufficiency/diagnosis , Hepatic Insufficiency/therapy , Renal Insufficiency/diagnosis , Renal Insufficiency/therapy , Fatty Liver/therapy , Pregnancy, TwinABSTRACT
Introducción. La progesterona es una hormona que favorece el mantenimiento del embarazo, es la protagonista de la fisiopatología del trabajo de parto pretérmino. De esta manera, se propone realizar una revisión sistemática que permita demostrar la utilidad de la progesterona natural micronizada en la mitigación de los efectos deletéreos del trabajo de parto pretérmino. Metodología. Revisión sistemática en la que se utilizaron los términos "MeSH" y "No MeSH". Se empleó el programa "Publish or Perish" y bases de datos como: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus y Google Scholar. Se incluyeron artículos de revisión, meta-análisis, artículos originales (publicaciones preliminares o completas), resúmenes de congresos, seminarios publicados, libros de texto, protocolos hospitalarios regionales y consensos nacionales, en donde cada autor evaluó individualmente cada artículo y aplicó la herramienta CASPE. Resultados. En la literatura no es posible encontrar pautas concisas internacionales sobre el uso de la progesterona micronizada frente a la amenaza de trabajo de parto pretérmino (TPP). En general, para la mitigación del trabajo de parto, según lo analizado por los autores, se recomienda usar progesterona natural micronizada en cápsulas de 100 a 400 mg/día vía oral o 100 a 200 mg cada 12 a 24 horas vía vaginal. Desde la semana 16 hasta la semana 36 de gestación por vía oral y desde la semana 24 a 34 de gestación por vía vaginal. Discusión. El uso de la progesterona micronizada ha demostrado mitigar complicaciones posteriores al trabajo de parto pretérmino, sin embargo, no hay consenso sobre la dosificación y las vías de administración. Sumado a lo anterior, los estudios analizados pueden contener sesgos, por lo que se deja a elección del clínico el uso este medicamento. Conclusiones. La progesterona natural micronizada podría ser empleada para mitigar el trabajo de parto pretérmino según los artículos analizados por los autores a lo largo de la revisión. Sin embargo, se necesitan más estudios para legitimar dicha hipótesis.
Introduction. Progesterone is a hormone that favors maintaining pregnancy. It is the protagonist of the physiopathology of preterm labor. In this sense, a systematic review is proposed to demonstrate the usefulness of natural micronized progesterone in mitigating the harmful effects of preterm labor. Methodology. A systematic review in which the terms "MeSH" and "No MeSH" were used. The "Publish or Perish" program was used, as well as databases, such as: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus, and Google Scholar. Review and meta-analysis articles, original articles (preliminary or complete publications), congress summaries, published seminars, textbooks, regional hospital protocols and national consensuses were included, in which each author individually assessed each article and applied the CASPE tool. Results. It was not possible to find concise international guidelines on using micronized progesterone for the threat of preterm labor (PTL) in literature. According to what the authors analyzed, for the mitigation of labor it is generally recommended the use of natural micronized progesterone in 100 to 400 mg/day capsules orally or 100 to 200 mg every 12 to 24 hours through the vagina. From week 16 to week 36 of pregnancy orally and from week 24 to 34 through the vagina. Discussion. Using micronized progesterone has demonstrated mitigating complications subsequent to preterm labor. However, there is no consensus on dosage and routes of administration. Added to the above, the analyzed studies may contain biases, reason why using this medication is left to the physician's discretion. Conclusions. Natural micronized progesterone can be used to mitigate preterm labor according to the articles the authors analyzed throughout the review. However, more studies are needed to validate this hypothesis.
Introdução. A progesterona é um hormônio que favorece a manutenção da gravidez, é a protagonista da fisiopatologia do parto prematuro. Dessa forma, propõe-se a realização de uma revisão sistemática que permita demonstrar a utilidade da progesterona natural micronizada na mitigação dos efeitos deletérios do trabalho de parto prematuro. Metodologia. Revisão sistemática em que foram utilizados os termos "MeSH" e "NãoMeSH". Foram utilizados o programa "Publish or Perish" e bases de dados como: Medline, PubMed, Embase, Clinical Key, Cochrane Library, Scopus e Google Scholar. Foram incluídos artigos de revisão, meta-análises, artigos originais (publicações preliminares ou completas), resumos de congressos, seminários publicados, livros didáticos, protocolos hospitalares regionais e consensos nacionais, onde cada autor avaliou individualmente cada artigo e aplicou a ferramenta CASPE. Resultados. Não é possível encontrar na literatura diretrizes internacionais concisas sobre o uso de progesterona micronizada diante da ameaça de trabalho de parto prematuro (TPP). Em geral, para a mitigação do trabalho de parto, conforme analisado pelos autores, recomenda-se o uso de progesterona natural micronizada em cápsulas de 100 a 400mg/dia por via oral ou 100 a 200mg a cada 12 a 24 horas por via vaginal. Da 16ª à 36ª semana de gestação por via oral e da 24ª à 34ª semana de gestação por via vaginal. Discussão. O uso de progesterona micronizada demonstrou mitigar as complicações após o trabalho de parto prematuro, no entanto, não há consenso sobre a dosagem e as vias de administração. Além do exposto, os estudos analisados podem conter vieses, pelo que cabe ao médico escolher o uso deste medicamento. Conclusões. A progesterona natural micronizada poderia ser utilizada para mitigar o trabalho de parto prematuro de acordo com os artigos analisados pelos autores ao longo da revisão. No entanto, mais estudos são necessários para legitimar essa hipótese.
Subject(s)
Progesterone , Pregnancy, Twin , 17 alpha-Hydroxyprogesterone Caproate , Systematic Review , Obstetric Labor, PrematureABSTRACT
The objectives of this study were to compare perinatal outcomes in twin pregnancies where the first twin was in the breech presentation. To do so, we performed a 10-year retrospective cohort study in a single university center. All patients with a twin pregnancy with the first twin in breech presentation, a gestational age greater than or equal to 34 weeks' gestation, and a birth weight >= 1500 g were included. The main outcome measures were 5-minute Apgar score <7 and perinatal mortality. We included 353 pairs of twins which complied with the inclusion criteria. One hundred and fifty (150) patients delivered vaginally while 203 pairs of twins were delivered by caesarean section. Patients who delivered abdominally were similar to those who delivered vaginally with regard to age, parity, and gestational age. Six twins A delivered vaginally and 2 delivered by caesarean section had an Apgar score < 7 (p = 0.76) whereas 12 twins B delivered vaginally and 2 delivered abdominally had an Apgar score <7 (p = 0.001). Perinatal mortality did not differ significantly between twins delivered abdominally and those delivered vaginally. There was no evidence that vaginal delivery was risky with regards to depressed Apgar scores for Twin A and neonatal mortality for breech first twins that weighed at least 1500 g. However, Twin B delivered vaginally were more likely to present with a low 5-minute Apgar score. Along with the literature, the findings of this study do not currently allow to define a consensual obstetric attitude towards management of breech first twin deliveries. Until more prospective multicenter randomized controlled studies shed light on this problem, the skills, experience and judgment of the obstetrician will play a major role in the decision-making process. (Afr J Reprod Health 2022; 26[5]: 50-56).
Subject(s)
Cesarean Section , Vaginal Birth after Cesarean , Pregnancy, Twin , Senegal , Pregnancy Outcome , Perinatal DeathABSTRACT
O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)
Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/surgery , Coronary Vessels/pathology , Dissection/adverse effects , Acute Coronary Syndrome/pathology , Myocardial Infarction/complications , Cesarean Section , Pregnancy, High-Risk , Pregnancy, Twin , Heart Disease Risk Factors , Hysterectomy , Myocardial Infarction/etiologyABSTRACT
OBJECTIVE@#To investigate the association between serum high sensitivity C-reaction protein (hsCRP) in early pregnancy and gestational diabetes mellitus (GDM) among twin pregnant women, and to explore the effects of the pre-pregnant body mass index (BMI) and gestational weight gain (GWG) status on such association.@*METHODS@#Twin pregnant women with pre-pregnant BMI greater than or equal to 18.5 kg/m2 were recruited at Department of Obstetrics and Gynecology of Peking University Third Hospital from March 2017 to December 2020. Serum samples collected in early pregnancy were analyzed for hsCRP using particle-enhanced immunoturbidimetric method. In the following visits, the information about GWG and GDM were prospectively collected in every trimester. The association effect between hsCRP tertiles and GDM were estimated using Logistic regression, and further converted into risk ratio (RR). Cochran-Mantel-Haenszel test and mediation analysis were used to explore the effects of BMI and GWG status on the association.@*RESULTS@#Among the included 570 twin pregnant women, 31.6% deve-loped GDM, 26.1% were pre-pregnant overweight or obesity, and 49.5% with GWG out of referenced range. After adjustment for confounding factors, risk of developing GDM in twin gestations with the middle tertile and highest tertile of serum hsCRP in early pregnancy were 1.42 fold (95%CI: 1.02-1.89) and 1.54 fold (95%CI: 1.12-2.02), respectively, compared with the lowest tertile of serum hsCRP, and there existed significantly linear trend (P=0.022). Findings from mediation analysis illustrated that pre-pregnant BMI had partial mediating effect on the association, and BMI accounted for 23.84% (P < 0.001) of the increasing GDM risks with elevated hsCRP. Joint analysis with hsCRP and GWG found that those who were with GWG out of referenced range accompanied with the higher hsCRP tertiles (>1.21 mg/L) had significantly 2.31 fold increased risk according to those who were with GWG in the referenced range accompanied with the lowest hsCRP tertile (≤1.21 mg/L, P < 0.01).@*CONCLUSION@#Elevated hsCRP in early pregnancy significantly increased GDM risk among twin pregnant women. The hsCRP-GDM association was dependent on GWG status, and pre-pregnant BMI had partial mediating effect on such association. It is suggested that twin pregnant women should consider systemic inflammation and gestational weight at the same time to reduce GDM risk.
Subject(s)
Female , Humans , Pregnancy , Body Mass Index , C-Reactive Protein/metabolism , Cohort Studies , Diabetes, Gestational/blood , Gestational Weight Gain , Pregnancy, Twin/blood , Weight GainABSTRACT
Abstract Conjoined twins (CTs) are a rare complication from monochorionic and monoamniotic twin pregnancies. We describe the use of 3D technologies, including 3D virtual and 3D physical models on prenatal evaluation of one parapagus CT. A 16-year-old G1P0 woman was referred for fetal magnetic resonance imaging (MRI) anatomical evaluation of a CT at 28 weeks of gestation. 3D images of the fetal surface were generated by the software during the examination for spatial comprehension of the relationship between the fetal parts. The pair of CTs died at the 32nd week of gestation, a few hours after cesarean section. 3D technologies are an important tool for parental counseling and preparation of the multidisciplinary care team for delivery and neonatal assistance and possible surgical planning for postnatal separation in CTs cases.
Resumo Gêmeos unidos (GUs) são uma complicação rara de gestações gemelares monocoriônicas e monoamnióticas. Descrevemos o uso de tecnologias 3D, incluindo modelos 3D virtuais e físicos, na avaliação pré-natal de GU parapagus. Mulher de 16 anos, G1P0, foi encaminhada para avaliação anatômica por ressonância magnética (RM) fetal de GU com 28 semanas de gestação. Imagens 3D da superfície fetal foram geradas pelo software durante o exame para compreensão espacial da relação entre as partes fetais. O par de GUs morreu na 32ª semana de gestação, poucas horas após a cesariana. As tecnologias 3D são uma importante ferramenta de aconselhamento dos pais e de preparação da equipe multiprofissional para o parto e a assistência neonatal, além de possível planejamento cirúrgico para separação pós-natal em casos de GUs.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Twins, Conjoined , Prenatal Diagnosis , Cesarean Section , Ultrasonography, Prenatal , Pregnancy, TwinABSTRACT
Objetivo: describir las características clínicas y la frecuencia de complicaciones maternas, fetales y neonatales, según técnica de anestesia neuroaxial (AN) en mujeres con síndrome de transfusión feto-fetal (STFF) tratadas con fotocoagulación láser (FL). Materiales y métodos: estudio de cohorte retrospectiva descriptivo. Se incluyeron gestantes con STFF tratadas con FL y AN en la Fundación Valle del Lili, Cali (Colombia) entre 2013-2017. Se excluyeron pacientes con STFF estadio-V de Quintero. Se usó estadística descriptiva. El protocolo fue aprobado por el Comité de Ética de la institución. Resultados: 32 participantes cumplieron con los criterios de inclusión y de exclusión. La población estuvo constituida por mujeres jóvenes, multíparas. En el 87,5% de los casos se realizó intervención de urgencia. El 43,7% presentaba el estadio-III de Quintero y en el 56,2 % de las gestantes se utilizó anestesia epidural. Las variables hemodinámicas maternas exhibieron un comportamiento similar, acorde al momento de la cirugía y la técnica neuoraxial implementada. El 65,6 % de las gestantes presentó hipotensión sostenida y el 9,3 % desarrolló edema pulmonar. El 65,6 % de las pacientes experimentó parto pretérmino y el 18,7 % ruptura prematura de membranas. Se registraron 14 muertes fetales y cinco neonatales. No se registraron casos de mortalidad materna. Conclusiones: en pacientes con STFF que requieren FL, el uso de la anestesia epidural, espinal o combinada probablemente se asocia con un comportamiento similar al de las variables hemodinámicas maternas, durante los momentos de la cirugía. Los profesionales que brindan atención a estas gestantes deben estar alerta ante la frecuente aparición de complicaciones maternas, fetales y neonatales. Se requieren estudios prospectivos que evalúen la seguridad y la efectividad de las diferentes técnicas de anestesia neuroaxial en pacientes con STFF.
Objective: To describe the clinical characteristics and the frequency of maternal, fetal and neonatal complications in accordance with the neuraxial anesthesia (NA) technique in women with twin-to- twin transfusion syndrome (TTTS) treated with laser photocoagulation. Materials and Methods: Descriptive retrospective cohort study of pregnant patients with TTTS treated with laser photocoagulation under NA at Fundación Valle del Lili, Cali (Colombia), between 2013-2017. Patients with Quintero stage VTTTS were excluded. The protocol was approved by the institutional ethics committee. Results: Of the participants, 32 met the inclusion and exclusion criteria. The study population consisted of young, multiparous women. Urgent interventions were performed in 87.5% of cases; 43.7% were Quintero stage III and epidural anesthesia was used in 56.2% of the women. Maternal hemodynamic variables were similar, in accordance with the timing of surgery and the neuraxial technique used. Sustained hypotension occurred in 65.6% of the pregnant women and 9.3% developed pulmonary edema. Pre-term delivery occurred in 65.6% of the patients and 18.7% had premature rupture of membranes. There were 14 fetal demises and five neonatal deaths. There were no cases of maternal mortality. Conclusions: In patients with TTTS requiring laser photocoagulation, the use of epidural, spinal or combined anesthesia is likely associated with similar maternal hemodynamic variables at the time of surgery. Practitioners providing care to these pregnant women must be aware of the frequent occurrence of maternal, fetal and neonatal complications. Prospective studies to assess the safety and effectiveness of the different neuraxial anesthesia techniques in patients with TTTS are required.
Subject(s)
Female , Pregnancy , Infant, Newborn , Fetofetal Transfusion , Pregnancy, Twin , Anesthesia, Epidural , Anesthesia, Spinal , Safety , Syndrome , Laser Coagulation , Fetoscopy , AnesthesiaABSTRACT
Resumen: La secuencia de perfusión arterial reversa (TRAP) es una complicación muy poco frecuente y grave de los embarazos gemelares monocoriónicos. Generalmente ocurre cuando el corazón de un gemelo de apariencia normal sirve como bomba para uno o más gemelos dismórficos cuya cabeza, órganos torácicos y extremidades superiores no se desarrollan completamente o no se desarrollan en absoluto y, por lo tanto, carecen de actividad cardíaca. La arquitectura placentaria vascular anómala provoca un cambio en el flujo arterial hacia el gemelo acardíaco. Los mecanismos fisiopatológicos exactos que conducen a este fenómeno devastador no se conocen bien. Compartiremos el caso clínico de una paciente de 19 años, cursando un embarazo gemelar monocorial monoamniótico, en que realizamos diagnóstico de TRAPS, y realizamos la coagulación laser de la arteria nutricia del feto acárdico.
Abstract: Twin reversed arterial perfusion sequence (TRAPS) is rather an unusual and severe complication of monochorionic twin pregnancies. It usually occurs when the normal-appearance heart of a twin acts as a pump for one or more dysmorphic twins whose head, thoracic organs and upper limbs fail to totally develop or do not develop at all and thus, have no cardiac activity. The abnormal vascular architecture at the placenta changes the arterial flow towards the acardiac twin. The exact pathophysiological mechanisms that result in this devastating phenomenon are still unknown. The study presents the clinical case of a 19-year- old patient pregnant with monoamniotic, monochorionic twins and a diagnosis of TRAPS, treated by laser coagulation of the acardiac twin's umbilical cord.
Resumo: A seqüência reversa de perfusão arterial (TRAPS) é uma complicação muito rara e grave de gestações gemelares monocoriônicas. Geralmente ocorre quando o coração de um gêmeo de aparência normal serve como uma bomba para um ou mais gêmeos dismórficos cuja cabeça, órgãos torácicos e membros superiores não se desenvolvem totalmente ou não se desenvolvem e, portanto, não têm atividade cardíaca. A arquitetura vascular placentária anormal causa uma mudança no fluxo arterial para o gêmeo acardíaco. Os mecanismos fisiopatológicos exatos que levam a esse fenômeno devastador não são bem compreendidos. Descrevemos o caso clínico de uma paciente de 19 anos, portadora de gestação gemelar monocoriônica monoamniótica, na qual fizemos o diagnóstico de TRAPS e realizamos coagulação a laser da artéria nutritiva do feto acardíaco.
Subject(s)
Humans , Female , Pregnancy , Adult , Laser Coagulation , Fetal Heart/abnormalities , Fetofetal Transfusion , Placenta/pathology , Umbilical Arteries/surgery , Pregnancy, TwinABSTRACT
Introdução: As malformações congênitas são defeitos que ocorrem durante o desenvolvimento embrio-fetal, principalmente entre a terceira e oitava semana de gestação, podendo ser suspeitado no período pré-natal. A atresia de esôfago com ou sem fístula traqueoesofágica pode estar associada a outras anomalias congênitas, como o ânus imperfurado, o qual faz parte uma síndrome denominada malformação anorretal. Objetivo: discutir o caso de um recém-nascido (RN) portador de atresia de esôfago tipo III e ânus imperfurado, bem como associar suas ocorrências simultâneas. Relato de caso: paciente do sexo masculino, advindo de uma gestação gemelar complicada por pré-eclâmpsia, apresentava ao nascimento ausência do reflexo de busca e sucção, bradicardia e cianose central. Foi diagnosticado com ânus imperfurado e atresia esofágica. Foram realizados cirurgia de Colostomia em Duas Bocas e tratamento cirúrgico da atresia de esôfago. O paciente ficou 48 dias em incubadora com intubação orotraqueal e ventilação mecânica por 26 dias. Resultado: a programação pós- alta indicada foi o acompanhamento com cirurgião pediátrico e neurocirurgião, tendo evoluído bem e aguardando anorretoplastia. Conclusão: o rápido diagnóstico é tão necessário, nesses casos, quanto as abordagens cirúrgicas. O apoio psicológico aos familiares é de extrema importância, pois visa a melhor aceitação da família frente ao caso, propiciando dessa forma, melhores prognóstico e tratamento do paciente.
Introduction: Congenital malformations are defects that occur during embryo-fetal development, especially between the third and eighth week of pregnancy, and may be suspected in the prenatal period. Esophageal atresia with or without tracheoesophageal fistula may be associated with other congenital anomalies, such as the imperforate anus, which is part of a syndrome called anorectal malformation. Objective: to discuss the case of a newborn (NB) with type III esophageal atresia and imperforate anus, as well as to associate its simultaneous occurrences. Case report: male patient, resulting from a twin pregnancy complicated by pre-eclampsia, had at birth the absence of the search and suction reflex, bradycardia and central cyanosis. He was diagnosed with imperforate anus and esophageal atresia. Double-barrel colostomy surgery and esophageal atresia surgery were performed. The patient spent 48 days in an incubator with orotracheal intubation and mechanical ventilation for 26 days. Results: the post-discharge schedule indicated was for follow-up with a pediatric surgeon and neurosurgeon. Patient evolved well and awaits anorectomy. Conclusion: rapid diagnosis is as necessary in these cases as surgical approaches. Psychological support to family members is extremely important, as it aims at better family acceptance in the case, thus providing better prognosis and treatment for the patient.
Subject(s)
Humans , Male , Infant, Newborn , Anus, Imperforate , Congenital Abnormalities , Tracheoesophageal Fistula , Digestive System , Esophageal Atresia , Case Reports , Pregnancy, TwinABSTRACT
Abstract Background: Kidney transplantation is associated with fertility restoration in more than 50% of women with chronic kidney disease. Pregnancy after transplantation may affect women's health and fetal development, with higher rates of abortion, fetal growth restriction, and neonatal deaths. Twin pregnancy is a condition of high-risk for adverse maternal and perinatal outcomes, and its occurrence in women with previous kidney transplantation is rare. Case: 32-year-old woman, recipient of living donor kidney transplantation, with a history of one pregnancy prior to transplantation, with current normal allograft function and no use of contraceptive method. At ten weeks of amenorrhea, ultrasound investigation showed a dichorionic diamniotic twin pregnancy. The following evaluation showed Chiari type II features in one fetus, and no detectable abnormality in the other one. There was appropriate blood pressure control with no need for an antihypertensive drug, and renal function remained normal without proteinuria. Calcium and a low dose of acetylsalicylic acid were used as preeclampsia prophylaxis. At 33 weeks of gestation, she presented premature rupture of membranes with spontaneous preterm labor. A cesarean section was performed due to the breech presentation of the first fetus. The patient persisted with normal graft function and without graft rejection during follow-up. Discussion and conclusion: Twin pregnancies after kidney transplantation are rare, and it is most frequently associated with preterm birth. We reported a successful twin pregnancy after kidney transplantation, with good perinatal and maternal outcomes, and without graft rejection or dysfunction.
Resumo Introdução: O transplante renal está associado à restauração da fertilidade em mais de 50% das mulheres com doença renal crônica. A gravidez após o transplante pode afetar a saúde das mulheres e o desenvolvimento fetal, com taxas mais altas de aborto, restrição de crescimento fetal e óbitos neonatais. A gravidez gemelar é uma condição de alto risco para as mães e de desfechos adversos perinatais, e sua ocorrência em mulheres com transplante renal prévio é rara. Caso: mulher de 32 anos de idade, receptora de transplante de rim de doador vivo, com histórico de uma gravidez antes do transplante, com função atual normal do enxerto e sem uso de método contraceptivo. Após 10 semanas de amenorréia, a investigação por ultrassonografia mostrou uma gravidez diamniótica dicoriônica. A avaliação a seguir mostrou características de Chiari tipo II em um feto e nenhuma anormalidade detectável no outro. Houve controle adequado da pressão arterial sem necessidade de medicamento anti-hipertensivo e a função renal permaneceu normal sem proteinúria. Cálcio e uma dose baixa de ácido acetilsalicílico foram usadas como profilaxia pré-eclâmpsia. Com 33 semanas de gestação, apresentou ruptura prematura de membranas com trabalho de parto prematuro espontâneo. Uma cesariana foi realizada devido à apresentação pélvica do primeiro feto. A paciente persistiu com função normal do enxerto e sem rejeição do enxerto durante o seguimento. Discussão e conclusão: gestações gemelares após transplante renal são raras e estão mais frequentemente associadas ao parto prematuro. Relatamos uma gravidez bem-sucedida após o transplante renal, com bons desfechos perinatais e maternos e sem rejeição ou disfunção do enxerto.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Pre-Eclampsia , Kidney Transplantation , Premature Birth , Cesarean Section , Pregnancy, TwinABSTRACT
OBJETIVOS: reportar el caso de una paciente con gestación gemelar monocorial-biamniótica complicada por secuencia TRAP que dio lugar al nacimiento de un feto bomba de 1932 gramos sin malformaciones anatómicas y de un feto acardio anceps de 1800 gramos, y realizar una revisión sobre esta patología y la importancia de su diagnóstico y tratamiento precoces. MATERIALES Y MÉTODOS: se presenta el caso de un feto acardio en una gestante con embarazo sin control estricto en el Hospital San Pedro de Logroño en el año 2019, de interés por su diagnóstico tardío y elevado peso al nacimiento del feto acardio. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed, OVID, Embase y SciE-LO con las palabras clave DeCS y términos MeSH. Como criterios de inclusión se consideraron artículos tipo series y reportes de casos y artículos de revisión desde enero de 1950 hasta enero de 2020. RESULTADOS: la búsqueda incluyó 39 referencias bibliográficas sobre las que se repasaron las principales cuestiones teóricas a exponer. El peso del feto acardio de nuestro caso fue muy elevado sin provocar repercusión en el feto sano, en comparación con la bibliografía, lo que aporta singularidad al caso, siendo sólo equiparable la serie de casos de Brassard et al (1999), con pesos de los fetos acardio por encima de 1700 gramos y diferenciándose en 100 gramos del feto bomba. CONCLUSIONES: el feto acardio es una complicación infrecuente de embarazos gemelares monocoriales. Se requiere la presencia de anastomosis vasculares placentarias entre ambas circulaciones. El diagnóstico precoz es importante para disminuir la morbilidad y usar, en la medida de lo posible, técnicas terapéuticas no invasivas.
OBJECTIVES: to report the case of a patient with a monochorionic-biamniotic twin gestation complicated by TRAP sequence that gave rise to the birth of a pump fetus without anatomical malformations (1932 g) and an acardiac anceps fetus (1800 g), and to review this pathology and the importance of its early diagnosis and management. MATERIAL AND METHODS: the case of an acardiac fetus is presented in a pregnant woman without strict control at the Hospital San Pedro de Logroño in 2019, worthwhile because of its late diagnosis and high birth weight. A search of the literature was carried out in the Medline databases via PubMed, OVID, Embase and SciELO with the MeSH terms. As inclusion criteria, we considered series-type articles and case reports, cohorts and review articles from January 1950 to January 2020. RESULTS: 39 bibliographic references were included with the main theoretical questions to be reviewed. Our acardiac fetus weight was very high comparing with the bibiography and without causing repercussion in the healthy fetus, which contributes to the uniqueness of the case, only the series report by Brassard et al (1999) is comparable, with weights of the acardiac fetus above 1700 grams and differing by 100 grams from the pump fetus. CONCLUSIONS: the acardiac fetus is an infrequent complication of monochorionic twin pregnancies. The presence of placental vascular anastomoses between both circulations is required. Early diagnosis is important to decrease morbidity and to use, as far as possible, non-invasive therapeutic techniques.
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications/diagnostic imaging , Diseases in Twins/diagnostic imaging , Fetofetal Transfusion/diagnostic imaging , Heart Defects, Congenital/diagnostic imaging , Perfusion , Pregnancy, Multiple , Abnormalities, Multiple/diagnostic imaging , Ultrasonography, Prenatal , Placental Circulation , Fetal Heart/diagnostic imaging , Pregnancy, Twin , Anencephaly/diagnostic imagingABSTRACT
ABSTRACT Introduction: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. Objectives: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. Methods: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero's staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. Results: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero's staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. Conclusion: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.
RESUMO Introdução: a síndrome de transfusão feto-fetal (STFF), definida pela combinação polidrâmnio-oligohidrâmnio, é a mais prevalente (5 a 35%) das anormalidades associadas às anastomoses vasculares placentárias e tem a maior letalidade (80 a 100%) se não tratada. A ablação a laser destes vasos por via fetoscópica com a técnica de Solomon é o tratamento de escolha atual para a interrupção das anastomoses vasculares. Objetivo: apresentar a experiência inicial do Serviço de Cirurgia Fetal do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) e comparar nossos resultados com os da literatura. Métodos: foram revisados os prontuários de todas as pacientes submetidas ao procedimento de ablação a laser, sendo analisados os dados referentes ao estadiamento de Quintero, à idade gestacional ao diagnóstico e ao procedimento, à posição placentária, à sobrevida imediata pós-procedimento e sobrevida após o período neonatal. Os dados foram então comparados com os mais recentes disponíveis na literatura. Resultados: dez casos de STFF foram analisados. Todos diagnosticados antes da 26a semana (mediana 20,79) e o intervalo diagnóstico-tratamento teve mediana de 9,5 dias. A distribuição pelo estadiamento de Quintero foi: três casos no estádio II, cinco casos no III e dois casos no IV. Em 50% das gestações pelo menos um dos fetos sobreviveu ao período neonatal. Conclusão: o tratamento da STFF no HC-UFPR impactou positivamente a sobrevida dos fetos acometidos. Entretanto, nossos resultados estão aquém dos reportados na literatura, possivelmente pelo demora no referenciamento das pacientes, com intervalo aumentado entre diagnóstico e tratamento.
Subject(s)
Humans , Female , Pregnancy , Twins, Monozygotic , Laser Coagulation/methods , Fetofetal Transfusion/surgery , Fetoscopy , Pregnancy Trimester, Second , Pregnancy Outcome , Survival Analysis , Survival Rate , Retrospective Studies , Gestational Age , Treatment Outcome , Fetofetal Transfusion/mortality , Pregnancy, Twin , HospitalsABSTRACT
OBJECTIVE@#To study the influence of twin pregnancy by assisted reproductive technology (ART) versus twin pregnancy by spontaneous conception (SC) on neonatal outcomes.@*METHODS@#A retrospective analysis was performed for the clinical data of 3 356 live twins with a gestational age of ≥24 weeks who were born in Nanjing Maternal and Child Health Hospital from 2017 to 2019, with 2 006 twins (1 003 pairs) in the ART group and 1 350 (675 pairs) in the SC group. The two groups were compared in terms of the mother's general information and pregnancy comorbidities and the general information, diseases, and outcomes of neonates.@*RESULTS@#Compared with the SC group, the ART group had a significantly higher maternal age (@*CONCLUSIONS@#Compared with twin pregnancy by SC, twin pregnancy by ART does not increase the neonatal mortality rate and risk of adverse outcomes.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Cesarean Section , Pregnancy Outcome , Pregnancy, Twin , Premature Birth , Reproductive Techniques, Assisted , Retrospective StudiesABSTRACT
OBJECTIVE@#To assess the value of non-invasive prenatal testing (NIPT) for the detection of fetal chromosomal aneuploidies in women with twin pregnancy.@*METHODS@#A total of 2473 women with twin pregnancy underwent the NIPT test to assess the risk for fetal chromosomal aneuploidies from January 2016 to September 2019. Those with a high risk by NIPT were confirmed by amniocentesis or chorionic villus sampling. All cases were followed up to evaluate the positive prediction value of NIPT for twin pregnancies.@*RESULTS@#Among the 2473 women, the NIPT test has identified 31 cases (1.25%) with a high risk for fetal chromosomal aneuploidies, which included 5 cases of trisomy 21, 1 case of chromosome 21 deletion, 4 cases of trisomy 18, 7 cases of sex chromosome abnormality and 14 cases of microdeletion and microduplication. By invasive prenatal diagnosis or chromosomal karyotyping analysis of neonates, 5 cases of trisomy 21, 3 cases of trisomy 18, 1 case of sex chromosome abnormality, and 2 cases of microdeletion and microduplication were confirmed, which yielded a positive predictive value of 100%, 75%, 25% and 25%, respectively.@*CONCLUSION@#NIPT can be used for the screening of fetal chromosomal aneuploidies in women with twin pregnancy with high accuracy. The method is non-invasive, safe and effective for the screening of fetal chromosomal aneuploidies, in particular trisomy 21.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Aneuploidy , Chromosome Disorders , Pregnancy, Twin , Prenatal Diagnosis , Trisomy , Trisomy 13 Syndrome , Trisomy 18 SyndromeABSTRACT
BACKGROUND@#Twin pregnancies continue to increase worldwide; however, the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons. We attempted to establish a set of fetal biometric references for Chinese twin pregnancies, stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic (SC-MCDA), spontaneously conceived dichorionic diamniotic (SC-DCDA), and assisted reproductive technology dichorionic diamniotic (ART-DCDA) twins.@*METHODS@#From 2016 to 2019, the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women, including fetal weight, biparietal diameter, head circumference, abdominal circumference, femur length, and humerus length. The linear mixed models were used to test the difference of growth patterns between groups, and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape.@*RESULTS@#A total of 929 twin pregnant women and 2019 singleton pregnant women, met the inclusion criteria. Among twin pregnancies, 148 were SC-MCDA, 215 were SC-DCDA, and 566 were ART-DCDA twins. Overall, SC-DCDA twins grew faster than SC-MCDA twins, while slower than ART-DCDA twins (all P < 0.05), and all of the three groups showed significant differences comparing with singletons, especially during the third trimester. Hence, the customized fetal growth charts of each fetal biometric parameter were, respectively, constructed for SC-MCDA, SC-DCDA, and ART-DCDA twins.@*CONCLUSIONS@#The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode. To fill the gap, we modeled fetal biometric parameters for Chinese SC-MCDA, SC-DCDA, and ART-DCDA twin pregnancies, hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.
Subject(s)
Female , Humans , Pregnancy , China , Fetal Development , Growth Charts , Pregnancy, Twin , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
Los defectos del esmalte dental en la dentición primaria en niños con antecedentes de prematuridad y bajo peso son frecuentes. Una de las causas de la prematuridad es el embarazo gemelar, que hace que la mayoría de los fetos sean prematuros debido al crecimiento intrauterino restringido. El objetivo de este trabajo es informar de la importancia de un diagnóstico correcto y precoz de la hipomineralización de los molares deciduos (HMD) en gemelos prematuros, así como de las posibilidades de tratamiento. Materiales y métodos: Dos niñas gemelas idénticas de 5 años que presentaban el mismo patrón de HMD en los dientes 55,65,75,85 ya con gran destrucción e historia de sensibilidad. Ya habían recibido atención odontológica, pero sólo una de las hermanas recibió tratamiento restaurador, la segunda no permitió el tratamiento, se utilizaron técnicas de manejo de la conducta, pero no fue posible realizar procedimientos operatorios. En el examen clínico y radiográfico se constató la posibilidad de realizar la técnica de Hall en los dientes 55,65 de la gemela 1 y 85 de la gemela 2. Resultados: Los dientes 75 y 85 de l a gemela 1, fueron diagnosticados clínica y radiográficamente con necesidad de restauración en resina compuesta, ya que estaban con restauraciones provisionales y asintomáticos. Los dientes 55 y 65 de lagemela 2 recibieron restauraciones ionoméricas y el diente 75 recibió una pulpectomía y una corona de acero. Conclusión: La técnica de Hall es muy bienvenida cuando se trata de rehabilitaciones en hipoplasia, especialmente cuando se trata del manejo de la edad joven, todavía hay diagnósticos erróneos cuando se examina una HMD(hipomineralización molar primaria)
Defeitos de esmalte dentário na dentição decídua são comuns em crianças com histórico de prematuridade e baixo peso. Uma das causas da prematuridade é a gestação gemelar, esta faz com que a maioria dos fetos sejam prematuros devido ao crescimento intrauterino restrito. O objetivo deste trabalho é relatar a importância de um diagnóstico correto e precoce de Hipomineraliação Molar Decíduo (HMD) em gêmeos prematuros, e as possibilidades de tratamento. Materiais e Métodos: duas crianças 5 anos sexo feminino gêmeas univitelinas que possuíam o mesmo padrão de HMD nos dentes 55,65,75,85 já com grande destruição e histórico de sensibilidade. As mesmas já receberam atendimento odontológico, porém apenas uma das irmãs recebeu tratamento restaurador, a segunda irmã não permitiu tratamento, técnicas de gestão comportamental foram utilizadas, mas não foi possível a realização dos procedimentos operatórios. Em exame clínico e radiográfico constatou-se a possibilidade de execução da técnica Hall nos dentes 55,65 da gêmea 1 e 85 da gêmea 2. Resultados: Os dentes 75 e 85 da gêmea 1, foram diagnosticados clinicamente e radiograficamente com necessidade restauradoraem resina composta,pois estavam com restaurações provisórias e assintomáticos. Os dentes 55 e 65 da gêmea 2 receberam restaurações ionoméricas e o dente 75 pulpectomia e coroa de aço. Conclusão: A Hall Technique é muito bem-vinda quando se trata de reabilitações em hipoplasias, principalmente no que tange ao manejo de pouca idade, ainda existem erros de diagnóstico na hora de examinar uma HMD (Hipomineralização Molar Decíduo)
Dental enamel defects in the primary dentition are common in children with a history of prematurity and low birth weight. One of the causes of prematurity is twin pregnancy, which causes most cases to be premature due to restricted intrauterine growth. The objective of this report is to relate the importance of a correct and early diagnosis and as treatment alternatives for of Deciduous Molar Hypomineraliation (DMH) in premature twins. Materials and methods: 5 years old, female, identical twins who had the same HMD pattern in their teeth 55,65,75,85 presented with a long history of destruction and sensitivity. They had previously received dental care. Only one of the sisters received restorative treatment. The other sister did not have
Subject(s)
Humans , Female , Child, Preschool , Dental Enamel Hypoplasia , Dental Enamel Hypomineralization/diagnosis , Dental Enamel , Pregnancy, Twin , Molar HypomineralizationABSTRACT
SUMMARY BACKGROUND: Asymmetric or heteropagus conjoined twins is a rare occurrence, with an incidence of one case in 1-2 million. Conjoined twins are classified according to their symmetry, place of fusion, and grade of duplication. METHODS: We report here an extremely rare presentation of parasitic twins not described before. We describe macro and micro anatomic alterations and discuss the aspects of this peculiar presentation and the importance of prenatal diagnosis. RESULTS: The case of a twenty-three-year-old patient, with monochorionic, monoamniotic asymmetrically-conjoined twin pregnancy, discovered at 29 weeks of gestational age. We believe that this report calls attention to this presentation and the importance of prenatal care and management. The twins were delivered vaginally without life. The twins' combined weight was 1.300 gr. They were bonded in the left cervical region. CONCLUSION: This report may help to find strategies for clinical decisions in future cases. Antepartum diagnosis is important to the management, preoperative planning, and outcomes. Prenatal imaging exams like echocardiography, CT, MRI, and ultrasonography are feasible and can provide relevant information about malformation severity and prognosis.
RESUMO BACKGROUND: Gêmeos parasitas assimétricos ou heterópagos são uma ocorrência rara, com incidência de um caso em 1-2 milhões. Os gêmeos siameses são classificados de acordo com sua simetria, local de fusão e grau de duplicação. MÉTODOS: Relatamos aqui uma apresentação extremamente rara de gêmeos parasitários não descritos anteriormente. São descritas alterações macro e microscópicas e discutidos aspectos relevantes dessa malformação e da importância do diagnóstico pré-natal. RESULTADOS: Um caso de uma paciente de 23 anos de idade, com gestação monocoriônica, monoamniótica de gêmeos siameses assimétricos diagnosticada com 29 semanas de idade gestacional. Acreditamos que este relato chama a atenção para esta apresentação e para a importância do cuidado e manejo pré-natal. Os fetos nasceram de parto vaginal já sem vida, pesando em conjunto 1.300 gramas, e eram unidos pela região cervical esquerda. CONCLUSÃO: Este relato pode ajudar a encontrar estratégias para a decisão clínica em casos futuros. O diagnóstico pré-natal é fundamental para o manejo e planejamento pré-operatório. Exames de imagem como ecocardiografia, tomografia computadorizada, ressonância magnética e ultrassonografia são factíveis e podem fornecer informações-chave sobre a gravidade e prognóstico da malformação.