Two hearts, one rhythm: A case report on thoracoomphalopagus twins / Philippine Journal of Obstetrics and Gynecology

A 21-year old woman, G1P0, was referred for further prenatal check-up with sonographic examination revealing conjoined twins at 29 weeks age of gestation. The fetuses were in breech presentation positioned face-to-face with fusion at the level of the thoraces and gastric bubble suggestive of thoracoomphalopagus twins. There was a definite communication between the two fetal circulations at the ventricular level as seen on fetal echocardiogram with a single cardiac rhythm shared between the two hearts. Close antenatal and fetal surveillance was done during the entire pregnancy duration. The patient was counseled about therapeutic options and explained of the complexity of their cardiac anatomy. The twins were delivered by cesarean section at 35 weeks due to preterm labor and a neonatal 2D-echocardiogram was done shortly after to re-assess their cardiac anatomy. Since the results revealed a shared ventricle, the twins were considered inseparable. The family was apprised of their poor prognosis and opted for natural death to occur.

Perineal endometriosis with anal sphincter involvement

Perineal endometriosis is a rare complication of episiotomy. This is a case of a 44-year old woman with cyclic perineal pain and a history of episiotomy. A wedge biopsy of the perineal mass confirmed the diagnosis of endometriosis. Awareness of the occurrence of this rare type of extrapelvic pain during menses secondary to perineal cudometriosis is important.