Abstract：
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.
METHODS: 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.
METHODS: 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.
摘要：
背景：单卵病，单绒毛膜三胞胎胎儿与一对连体双胞胎极为罕见（接近百万分之一的婴儿），给其管理带来挑战，预后不良。
方法：我们报告一例单绒毛膜羊膜三胎妊娠，14周时的超声检查显示一对连体的胸椎胎儿，分享心,肝脏,和脐带,除了脐膨出.第三个胎儿,没有畸形，呈现与双胎对双胎输血综合征相容的早期心力衰竭的迹象。决定在18周时进行期待管理，三个胎儿发生宫内死亡。流产是通过子宫切开术进行的。
结论：讨论了这些病例的治疗方法，提出了三种管理方案：预期管理，选择性减少连体胎儿，或终止妊娠。对文献的回顾发现只有12例具有这种病理组合，其中只有3个正常胎儿（25％）存活，没有一个连体双胞胎存活。据我们所知,该病例是单绒毛膜三胎妊娠合并合并早期双胎对双胎输血的首例。
方法：我们报告一例单绒毛膜羊膜三胎妊娠，14周时的超声检查显示一对连体的胸椎胎儿，分享心,肝脏,和脐带,除了脐膨出.第三个胎儿,没有畸形，呈现与双胎对双胎输血综合征相容的早期心力衰竭的迹象。决定在18周时进行期待管理，三个胎儿发生宫内死亡。流产是通过子宫切开术进行的。
结论：讨论了这些病例的治疗方法，提出了三种管理方案：预期管理，选择性减少连体胎儿，或终止妊娠。对文献的回顾发现只有12例具有这种病理组合，其中只有3个正常胎儿（25％）存活，没有一个连体双胞胎存活。据我们所知,该病例是单绒毛膜三胎妊娠合并合并早期双胎对双胎输血的首例。
