- Article
- Published:
- Patricia S. Greco ORCID: orcid.org/0000-0002-3347-14451,
- D’Angela Pitts1nAff5,
- William J. Weadock ORCID: orcid.org/0000-0002-1414-45532,3,
- Maria Ladino-Torres2,3,
- Naomi T. Laventhal ORCID: orcid.org/0000-0002-8110-76212,4,
- George Mychaliska4,
- Marjorie C. Treadwell1 &
- …
- Alissa Carver1
Journal of Perinatology volume41,pages 2424–2431 (2021)Cite this article
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Subjects
- Outcomes research
- Pregnancy outcome
Abstract
Objective
Obstetricians infrequently encounter conjoined twins. Much of the clinical care literature focuses on postnatal management from a neonatology and pediatric surgery perspective; guidance on obstetrical management is limited. We outline steps for prenatal evaluation, obstetrical care, and delivery planning.
Study design
Experiences with two cases of conjoined twins.
Results
We identified several points throughout the planning, delivery, and postnatal process that are important to highlight for optimizing clinical outcome, patient safety, and parental satisfaction.
Conclusion
After diagnosis, patients should be referred to a center experienced in the management of conjoined twins. Specialists in fields including maternal fetal medicine, pediatric surgery, neonatology, and radiology play a vital role in the management of these patients. Early referral allows for timely family counseling and decision-making. Prenatal evaluation beyond the first trimester should include a detailed ultrasound, fetal echocardiogram, and fetal MRI. 3D printed life-sized models can improve delivery planning and patient understanding.
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Data availability
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
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Author information
Author notes
D’Angela Pitts
Present address: Henry Ford Health System, Detroit, MI, USA
Authors and Affiliations
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
Patricia S. Greco,D’Angela Pitts,Marjorie C. Treadwell&Alissa Carver
Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
William J. Weadock,Maria Ladino-Torres&Naomi T. Laventhal
Department of Radiology, University of Michigan, Ann Arbor, MI, USA
William J. Weadock&Maria Ladino-Torres
Department of Surgery, University of Michigan, Ann Arbor, MI, USA
Naomi T. Laventhal&George Mychaliska
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- Patricia S. Greco
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- D’Angela Pitts
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- George Mychaliska
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- Marjorie C. Treadwell
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- Alissa Carver
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Contributions
PG formulated the concept of the paper, wrote the entire manuscript, researched prior publications, and corresponded with the co-authors on their input. DP provided input on the manuscript. WW and ML created the images and models used in the described cases and provided input on the manuscript. NL provided input on the manuscript. GM provided input on the manuscript. AC helped with formulation of the concept behind the paper, researched prior publications and provided input on the manuscript. MT helped with formulation of the concept behind the paper, researched prior publications and provided input on the manuscript. All authors approved the final submitted version of the manuscript and agree to be accountable for all aspects of the work.
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Correspondence to Patricia S. Greco.
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Conflict of interest
The authors declare no competing interests.
Ethics approval and consent to participate
This study was performed in accordance with the Declaration of Helsinki. Both patients signed consent to participate in this review.
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Supplementary information
41372_2021_1107_MOESM6_ESM.tif
Supplementary Figure 4. Conjoined twins placed immediately in thermoregulatory bag and hat placed on twin A on surgical field in Case 1
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Greco, P.S., Pitts, D., Weadock, W.J. et al. Conjoined twins: an obstetrician’s guide to prenatal care and delivery management. J Perinatol 41, 2424–2431 (2021). https://doi.org/10.1038/s41372-021-01107-5
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DOI: https://doi.org/10.1038/s41372-021-01107-5