Xipho-Omphalopagus Conjoined Twins in a Spontaneous Triplet Pregnancy: Autopsy Findings

A 20-year-old woman, gravid-1 para-0, was referred to the Gynaecology and Obstetrics Department at 21-weeks gestation with a diagnosis of CT in a spontaneous triplet pregnancy. There was no history of twinning in the family and medication use during early pregnancy. At referral, transvaginal ultrasound revealed a monochorionic-diamniotic triplet pregnancy with a set of CTs. One amniotic sac contained a single female foetus; the second amniotic sac had a set of CT fused through the thorax and abdomen. They had two heads, separate hearts and stomachs, two pelvises, four arms and four legs. An extensive counselling of the parents was done regarding the management options. The parents opted termination of pregnancy. Autopsy revealed a normal female foetus and a set of CTs (Fig. 1).The conjoined foetuses were xipho-omphalopagus, joined in midline, from the lower part of the sternum to the umbilicus. They shared a single umbilical cord with two umbilical arteries and two umbilical veins. They had separate chests, separate hearts and lungs with a continuous diaphragm. They shared a common centrally placed fused liver. The intestines were also fused from the mid portion of duodenums to distal ileum. Normal kidneys, urinary bladders, and female genital tracts were noted in each of the twins.