What is Cranio-cephalopagus?AHMED ZAKI, MRCOGHead of OB/GYN Department, Bakhsh HospitalChairman of Scientific Committee
Twins (MZ/DZ)
Conjoined twins • Are rare and complex complication of   monozygotic twinning, which is associated with   high perinatal m...
Such twins are classified according tothe site of connection: • the thorax (thoracopagus) • abdomen (omphalopagus), • sacr...
Conjoined Twins
Double-headed monsters (1:85 conjtwins)
With introduction of high-resolution imaging, accurateprenatal diagnosis of conjoined twins is possible early inpregnancy
cephalopagus
History • 28 Y, G3P2. H/O consanguinity • 1st delivery SVD (normal girl) • 2nd delivery , preterm with multiple cong. Abns...
•   At 36 weeks, she came in labour•   Her CTG showed typical picture of fetal distress•   & the os was 3 cm dilated, head...
Delivery
:ήθ ϨθΦέΎ         ϟϳ Φ Η                                              :ϰϟ                                                 ...
Diagnosis • Cranio-Cephalopagus twins are misdiagnosed as   a singleton pregnancy because of the extreme   degree of fusio...
• Ultrafast MR imaging can provide image quality superior to  two dimensional ultrasonography and should be considered  an...
Diagnosis • Although first-trimester diagnosis of conjoined   twins is feasible, false-positive cases are common   before ...
Outcome• As most parents opt for immediate  termination of pregnancy at confirmation of  the diagnosis, there are limited ...
• The prognosis for cephalopagus twins is  extremely poor because surgical separation is not  an option. Thus early prenat...
• I am presenting an extremely rare case of  cephalo-carniopagus• To the best of my knowledge, this is an extremely  rare ...
Never take yourself for granted
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cranio-Cephalopagus

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cranio-Cephalopagus

  1. 1. What is Cranio-cephalopagus?AHMED ZAKI, MRCOGHead of OB/GYN Department, Bakhsh HospitalChairman of Scientific Committee
  2. 2. Twins (MZ/DZ)
  3. 3. Conjoined twins • Are rare and complex complication of monozygotic twinning, which is associated with high perinatal mortality. (1:100,000 deliveries) • Represent a unique challenge to pediatric surgeons and radiologists. • Each set of conjoined twins is unique. An imaging strategy to accurately define anatomic fusion, vascular anomalies, and other associated abnormalities is important for surgical planning and prognostic information.
  4. 4. Such twins are classified according tothe site of connection: • the thorax (thoracopagus) • abdomen (omphalopagus), • sacrum (pygopagus), • pelvis (ischiopagus), • skull (craniopagus), • brain (cephalopagus), • or back (rachipagus). • Cephalopagus is a very rare form of conjoined twins.
  5. 5. Conjoined Twins
  6. 6. Double-headed monsters (1:85 conjtwins)
  7. 7. With introduction of high-resolution imaging, accurateprenatal diagnosis of conjoined twins is possible early inpregnancy
  8. 8. cephalopagus
  9. 9. History • 28 Y, G3P2. H/O consanguinity • 1st delivery SVD (normal girl) • 2nd delivery , preterm with multiple cong. Abns died at birth. This was followed by PPH, DVT • This pregnancy, booked at 10 weeks • At 22 Weeks, she had an anomaly scan which showed no abnormalities , • At 34 weeks, polyhydramnios..GTT..Diabetic..Diet control (her Bl. Gluc was always within normal)
  10. 10. • At 36 weeks, she came in labour• Her CTG showed typical picture of fetal distress• & the os was 3 cm dilated, head floating• She was taken to theatre for C/S
  11. 11. Delivery
  12. 12. :ήθ ϨθΦέΎ ϟϳ Φ Η :ϰϟ ·1 1429/11/16ΔόϤ ϟ ήϗ ϟϫ ΠΠ ϮϤή Γ Ϲ β β Ϡβ β έ /Γ Ύ έέΩΩ Πϣ β ϴ Ω όγ - ϡ2008/11/14 Í ϟ ϮϤή ήϗ ϟ Γ Ϲ β β Ϡβ ϧβ ΐ Ύ/Γ Ύ έέΩΩ Πϣ βέΐ Ύ Ω ϴ όγ - ϮϤή ήϗ ϟ Γ ΩΩ β Ϡβ β έΪϋΎ ϣ /Γ Ύ έέ Ϲ β Πϣ β δ ϴ Ω όγ - ϮϤή ήϗ ϟ ϡόϟ ΐΐήϤή /Γ Ύ Ύόΐ ϟ ϗ Ω όγ - ϮϤή ήϗ ϟ ήή ϟϳ ς ϴ Θ ήή Ϯ ϭΩ ήτΘ τΨϟ Ϊ /Γ Ύ Θ Θ ϳϣ όγ - 2968 :Ω ϟ Ϣ Ϊόό ϗέ ϮϤή ήϗ ϟ ΓΎ Ϸ Βϛ Ω Β σήήϴ Ύ σ /Γ όγ - 29 :Δ ϔ ϟ Τμ μ ϮϤή ήϗ ϟ ϱ έέΩΩ ΪϳϤ /Γ Ύ ϟ Ϲ ήή ΪΪ Ω όγ - Ϧϳ ήϗ ϟ ζ Ψ .Ω ϴ δ ϣϡ ϋϋϋέΪϣ/Γ Ύϟ - ϮϤή Α ΕΎϔθΘ ϮϤ Ω δ δ ϰϟϷ Δ μ ϟήΒ ϟϔϟ έΎ Ϲ ϭ ΤΤ Ύ ΨΨ ·Γ η η Α ϰ Δ ΎόΕΎ όϗ ϖϳϮδΘ Γ Ω ϴ κ κΎϊ ϣ ϣόϟ Ύ ϟ Ύόϼϭ ϟ έέ ·ΕΎΤΗ Χ Θ ϟ
  13. 13. Diagnosis • Cranio-Cephalopagus twins are misdiagnosed as a singleton pregnancy because of the extreme degree of fusion which makes accurate demonstration of the abnormalities very difficult • Ultrafast magnetic resonance imaging (MRI) has been used successfully in antenatal diagnosis. • ITS TOO RARE TO BE MIS S ED
  14. 14. • Ultrafast MR imaging can provide image quality superior to two dimensional ultrasonography and should be considered an adjunct to ultrasound for antenatal characterization of some anomalies.• where 3D imaging was used indicates that this modality does not improve on the diagnosis made by 2D ultrasound. Overall, very early prenatal diagnosis and first-trimester 3D imaging provide very little additional practical medical information compared to the 11-14 weeks ultrasound examination.•
  15. 15. Diagnosis • Although first-trimester diagnosis of conjoined twins is feasible, false-positive cases are common before 10 weeks because, earlier in gestation, fetal movements are limited and monoamniotic twins may appear conjoined.
  16. 16. Outcome• As most parents opt for immediate termination of pregnancy at confirmation of the diagnosis, there are limited data on the prenatal follow-up of conjoined twins.• When the parents opt for conservative management, half of the fetuses die in utero and another 44% will die during the neonatal period.
  17. 17. • The prognosis for cephalopagus twins is extremely poor because surgical separation is not an option. Thus early prenatal diagnosis of cephalopagus twins is important to provide an opportunity for pregnancy termination if desired.
  18. 18. • I am presenting an extremely rare case of cephalo-carniopagus• To the best of my knowledge, this is an extremely rare case in the whole literature
  19. 19. Never take yourself for granted

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