title: [Conjoined twins: prenatal diagnosis, delivery and postnatal outcome].
abstract: OBJECTIVE
  The aim of this study was to analyze conjoined twins in terms of antenatal, delivery and postnatal aspects.
  
  
  METHODS
  A retrospective descriptive analysis of prenatally diagnosed conjoined twins. Prenatal ultrasound and echocardiography, delivery details, postnatal follow-up, surgical separation and post mortem data were reviewed. The twins were classified according to the type of fusion between fetal structures. The following data were analyzed: ultrasound and echocardiographic findings, antenatal lethality and possibility of surgical separation, delivery details and survival rates.
  
  
  RESULTS
  Forty cases of conjoined twins were included in the study. There were 72.5% cases of thoracophagus, 12.5% of paraphagus, 7.5% of omphalo-ischiophagus, 5.0% of omphalophagus, and 2.5% of cephalophagus. Judicial termination of pregnancy was requested in 58.8% of the cases. Cesarean section was performed in all cases in which pregnancy was not terminated. The mean gestational age at delivery was 35 weeks; all twins were live births with a mean birth weight of 3,860 g and 88% died postnatally. Ten percent of the live borns were submitted to surgical separation with a 60% survival rate. The total survival rate was 7.5% and postnatal survival was 12%. Antenatal evaluation of lethality and possibility of surgical separation were precise. There were no maternal complications related to delivery.
  
  
  CONCLUSIONS
  Conjoined twins present a dismal prognosis mainly related to the complex cardiac fusion present in the majority of cases with thoracic sharing. At referring centers, prenatal ultrasound and echocardiographic evaluation accurately delineate fetal prognosis and the possibility of postnatal surgical separation.
authors.affiliation: Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. mlbrizot@uol.com.br
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Brizot
authors.forename: Adolfo Wenjaw
authors.initials: AW
authors.lastname: Liao
authors.forename: Lilian Maria
authors.initials: LM
authors.lastname: Lopes
authors.forename: Marcos Marques
authors.initials: MM
authors.lastname: Silva
authors.forename: Vera
authors.initials: V
authors.lastname: Krebs
authors.forename: Regina
authors.initials: R
authors.lastname: Schultz
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D014428:Twins, Conjoined / Q000601:surgery*; D016216:Ultrasonography, Prenatal