Prenatal Diagnosis of a Rare Dicephalic Parapagus Twin at 21 Weeks: A Case Report
Keywords:
Dicephalic parapagus twin, MRI, Perinatal diagnosis, UltrasoundAbstract
Background: Dicephalus parapagus twinning (DPT) is the rarest conjoined twinning entity of all conjoined twins. The presence of DPT is always associated with mortality before or after delivery. Antenatal diagnosis is crucial for planning labor, assembling a team, and providing counseling. Case presentation: A 23-year-old patient (G2P1A0) at 21 weeks of pregnancy attended the ultrasound clinic for routine care. A monoamniotic-monochorionic pregnancy was observed; the twin fetuses had two heads but one body, which corresponded to dicephalus parapagus twinning. A detailed ultrasound and fetal echocardiography reveal one heart without congenital anomalies. The liver, kidneys, and bladder appeared to be normally developed. Fetal MRI and karyotyping were not carried out after counseling the parents regarding the poor outcome. A multidisciplinary team followed the case; the patient chose to continue the pregnancy. A planned elective cesarean delivery was done at 36 weeks in a tertiary medical facility. A 3,200 g newborn baby boy was delivered alive; however, he quickly developed respiratory insufficiency and failure of heart function. He deceased within 4 hours of birth; an autopsy was declined. Conclusion: The prenatal diagnosis of DPT helps manage the case thoroughly and carefully to avoid maternal complications. All cases of DPT have a very poor prognosis. Prenatal confirmation permits structured, proactive management rather than emergent, multidisciplinary responses.
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