IMR Press / CEOG / Volume 45 / Issue 5 / DOI: 10.12891/ceog4295.2018

Clinical and Experimental Obstetrics & Gynecology (CEOG) is published by IMR Press from Volume 46 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Case Report
Two-headed twin in a triplet pregnancy after in vitro fertilization – A case report and review of the literature 
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1 Students' Scientific Club of Neonatology, Wrocław Medical University, Wrocław, Poland
2 Department of Neonatology, Wrocław Medical University, Wrocław, Poland
Clin. Exp. Obstet. Gynecol. 2018, 45(5), 782–786; https://doi.org/10.12891/ceog4295.2018
Published: 10 October 2018
Abstract

Conjoined twins (CT) in triplet pregnancies are especially rare, approximately less than one in a million deliveries. Purpose: For better understanding of such malformations the authors performed a review of the literature published in the era of sonographic imaging, concerning CT in triplet gestations, as well as in the multiple pregnancies conceived by artificial reproduction (assisted reproductive techniques, ART). Case Report: A 26-year-old primigravida who underwent in vitro fertilization with embryo transfer (IVF-ET) was diagnosed with dichorionic, diamniotic triplet gestation. In the 33th week of pregnancy, a healthy male singleton was born, together with paraphagus dicephalus dibrachius dipus twins. Results: This is one of only a few cases reported in the literature of a lively born neonate with such malformations, its uniqueness even increased by the occurrence in triplet gestation conceived with ART. The literature reports three options for the triplet pregnancy with a CT: its continuation with an enhanced risk of premature delivery, termination of the entire gestation, or selective feticide of the CT. In the present case, although the defect was detected in the first trimester, no fetal reduction was performed and both infants were born alive. No intervention was deemed appropriate as the healthy singleton was uneventfully delivered and discharged home. Conclusions: ART, such as IVF-ET, are related to a higher prevalence of monozygotic twins, implying that the procedure might also increase the occurrence of CT. Notwithstanding the rarity of CT in triplets, such gestations are a significant challenge for the proper diagnosis and maintenance.
Keywords
Conjoined twins
Triplet pregnancy
Artificial reproduction
In vitro fertilization
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