Moscow regions Research Institute of Obstetrics and Gynecology, Medical-Genetics Department, Moscow, Russia.

A 24-year-old woman (P3 G1) was sent to our institute at 13 weeks of gestation. Our examination revealed multiple fetal structural anomalies:

- duplication of the spine below thoracic region;
- dorsal defect in the lumbosacral region with protrusion of fetal liver and bowel loops.

Despite of the findings, the parents opted for the continuation of the pregnancy.

13 weeks:

Image 1: The image shows 3D image of the fetus with dorsal mass representing dorsal defect in the lumbosacral region with protrusion of fetal liver and bowel loops of the heteropagus conjoined twins.

Video 1: The video shows spina bifida at the level of common thoracic part of the conjoined heteropagus twins and division and continuation of two separate spines of the twins.

Another examination was done at 19 weeks and following anomalies were found:
- cerebral ventriculomegaly with Arnold-Chiari malformation type II; ventriculomegaly;
- duplication of the spine below thoracic region and spina bifida with a skin defect at the level of the dorsal division of the fetus with protrusion of bowel loops;
- two livers and three kidneys were present;
- single umbilical artery.

This time the parents opted for the termination of the pregnancy and the findings were confirmed.

19 weeks:

Images 2, 3: The images show common fetal head of the conjoined heteropagus twins with Arnold Chiari malformation.

Images 4, 5: The image 4 shows spina bifida at the level of common thoracic part of the conjoined heteropagus twins and division and continuation of two separate spines of the twins. Image 5 shows part of the two separate spines of the conjoined twins (fingers point at the separate spines).

Image 6: The image shows two of the three kidneys that were found in this case of conjoined heteropagus twins.

Images 7, 8: The images show 3D images of the division and continuation of two separate spines of the conjoined heteropagus twins.

Videos 2, 3, 4: The videos show spina bifida at the level of common thoracic part of the conjoined heteropagus twins and division and continuation of two separate spines of the twins.

Pathological images after termination of the pregnancy: 

Images 9, 10: The image 9 shows two livers of the heteropagus twins (1, 2). The image 10 shows three kidneys that were found in the heteropagus conjoined twins.

Images 11, 12, 13, 14, 15: The images show the heteropagus conjoined twins with spina bifida at the level of common thoracic part; two separate spines (images 13, 14); dorsal defect in the lumbosacral region with protrusion of fetal liver and bowel loops (image 15).