Hemodynamic Analysis of Cephalothoracopagus by the Color Doppler Method
A Comparison to Normal Fetuses via a Longitudinal StudyIura T. · Makinoda S. · Sasakura C. · Hirosaki N. · Inoue H. · Waseda T. · Watanabe Y.
Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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In a case of cephalothoracopagus, the umbilical artery (UA) was observed with color Doppler method, and the findings were compared with the hemodynamics of 46 normal fetuses. The patient was a 25-year-old primigravida who had appeared for routine prenatal visits since her 6th week of pregnancy. At a later time, the patient was examined after an interval of 4 weeks. Although an ultrasonography was also conducted, unfortunately, any findings of cephalothoracopagus were not detected. In the 25th week of gestation, we hospitalized her for marked polyhydramnios (amniotic fluid index: 280 mm), at which time an ultrasound examination revealed cephalothoracopagus. In the UA, the Vmax was 30.3 cm/s (normal fetus at 25–28 weeks: 33.5 ± 3.9 cm/s). The UA hemodynamics fell below the normal range. At 26 weeks, the UA Vmax was 56.5 cm/sec, a level which significantly exceeded the normal range. The patient underwent a cesarean section at 27 weeks of gestation; the indication was fetal distress. This is caused by the condition in which the fetal heart beats decreases to 90 beats per minute 3 times during a 10-min period as measured on the cardiotocograms. She delivered a 1,392-gram female with an Apgar score of 2 points (respiratory 1 point and heart rate 1 point). The infant was a cephalothoracopagus, with one head, two hearts, four upper limbs, and four lower limbs. The neonate died from circulatory failure 56 min after birth.
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