RESUMO
BACKGROUND: The condition of monozygotic, monochorionic triplet fetuses with a pair of conjoined twins is extremely rare (close to one in a million births), presents challenges in its management, and with poor prognosis. CASE REPORT: We report a case of monochorionic diamniotic triplet pregnancy, ultrasound at 14 weeks shows a pair of conjoined thoracopagus fetuses, sharing heart, liver, and umbilical cord, in addition to omphalocele. The third fetus, without malformations, presents signs of early heart failure compatible with twin-to-twin transfusion syndrome. It was decided to carry out expectant management where at 18 weeks, intrauterine death of the three fetuses occurs. An abortion is performed by hysterotomy. CONCLUSIONS: The treatment in these cases is discussed, three management options have been proposed: expectant management, selective reduction of the conjoined fetuses, or termination of the pregnancy. A review of the literature found only 12 cases with this combination of pathologies, in which only 3 normal fetuses (25%) survived and none of the conjoined twins survived. To our knowledge, this case is the first of a monochorionic triplet pregnancy with conjoined fetuses complicated with early twin-to-twin transfusion.
Assuntos
Transfusão Feto-Fetal , Gravidez de Trigêmeos , Gêmeos Unidos , Feminino , Gravidez , Humanos , Transfusão Feto-Fetal/complicações , Morte Fetal/etiologia , Feto/anormalidadesRESUMO
Se presentan dos casos de pielonefritis aguda complicada. El primero de ellos evolucionó con un Síndrome de Distress respiratorio del adulto; el segundo inicialmente simuló un cuadro de abdomen agudo, evolucionando también con algún grado de compromiso respiratorio.
In this oportunity we analize two cases of acute pyelonephritis during pregnancy that happened in the Hospital Barros Luco, the first case got complicated with an adult respiratory distress syndrome, the second case inicially was diagnosed as an acute abdomen, and throughout its evolution got complicated as well with a respiratory compromise.
