title: Conjoined twins pregnancies: experience with 36 cases from a single center.
abstract: OBJECTIVE
  To review a single center's experience in the management of twin pregnancies with conjoined fetuses.
  
  
  METHODS
  Retrospective study describing prenatal findings, delivery details, surgical treatment and perinatal outcome.
  
  
  RESULTS
  The study included 36 twin pregnancies with conjoined twins seen over a period of 12 years in a single tertiary hospital: 69.4% were thoracopagus, 13.9% parapagus, 8.3% omphaloischiopagus 5.6% omphalopagus and 2.8% cephalopagus. Cardiac defects were present in 91.6% of twin pairs and associated malformations were present in 61.8% of the cases: limb abnormalities in 36.1%, abdominal wall defects in 25.0%, cleft lip and/or palate in 13.9% and congenital diaphragmatic hernia in 5.5%. Surgical separation was considered not feasible and prognosis lethal in 30 (83.3%) cases. Termination of pregnancy was performed in 12 pregnancies of poor prognosis. Cesarean section was performed in all remaining cases. Five sets of twins underwent surgical separation and six children survived. Overall survival in our series was 8.3% and, among the livebirths, 13.6%.
  
  
  CONCLUSIONS
  Conjoined twin pregnancies should be referred to tertiary centers for detailed fetal anomaly and echocardiographic assessment to evaluate prognosis and determine the possibility of postnatal surgical separation.
authors: Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, SP, Brazil. mlbrizot@uol.com.br
authors: M L
authors: ML
authors: Brizot
authors: A W
authors: AW
authors: Liao
authors: L M
authors: LM
authors: Lopes
authors: M
authors: M
authors: Okumura
authors: M S
authors: MS
authors: Marques
authors: V
authors: V
authors: Krebs
authors: R
authors: R
authors: Schultz
authors: M
authors: M
authors: Zugaib
mesh_terms: D000328:Adult; D001938:Brazil; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D014428:Twins, Conjoined / Q000473:pathology* / Q000601:surgery; D055815:Young Adult