Conjoined twins associated with a normal singleton: very early diagnosis and successful selective termination

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Abstract
Conjoined twins were diagnosed at 10 weeks of gestation in a triplet pregnancy obtained by means of in vitro fertilization. Vaginal scan evidenced craniopagus twins associated with a singleton. Considering the poor and unpredictable prognosis, selective terminations of twins was successfully performed.Clinicians at the Fetal Medicine Unit in Montpellier Cedex in France used vaginal scan to examine a 27-year old woman who physician transferred 2 embryos into her uterus by in vitro fertilization. The ultrasound showed 2 gestational sacs and 2 separate placentas. The anatomy and length of the embryo closest to the cervix were normal. Yet the other sac had 2 embryos each with a separate chest, abdomen, and limbs but they shared the same head. They did not move even after uterine mobilization. The physicians diagnosed the 2 embryos as conjoined twins. They explained the risk of this type of pregnancy, of triplets, and of a monoamniotic twin pregnancy and poor prognosis of craniopagus twins to the parents. After weighing their choices for 1 week, they chose selective termination of the abnormal pregnancy to increase the odds of giving birth to the normal embryo. A physician used a 22 gauge needle to inject 3 ml potassium chloride into the gestational sac with the conjoined embryos. Ultrasound examination on the following day indicated that the normal embryo was alive and the twins were dead, so the physicians discharged the women. She returned every 15 days for ultrasound examinations to confirm the progressive vanishing of the conjoined embryos. The woman gave birth to a normal healthy child. This is the 1st reported case of selective abortion of craniopagus twins after ultrasound identified the abnormal twins and a normal singleton embryo at 10 weeks' gestation.

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