Twin reversed arterial perfusion syndrome in a monochorionic monoamniotic twin pregnancy.

OBJECTIVE: Twin-Reversed Arterial Perfusion (TRAP) sequence is a rare complication of monochorionic multiple gestation. Conservative management should be considered if there is no poor prognostic factor. CASE REPORT: This is a 35 year-old female with twin pregnancy with acardiac monster. Under the request of the patient, there was no intervention during the whole pregnancy. We keep regular and close sonography weekly follow up. There was no maternal complication and there was also no heart failure sign or polyhydramnios of the donor twin. Minimal blood flow was noted at the anastomotic vessels under the sonography at late gestational age. Due to breech presentation, cesarean section was performed at gestational age 37 + 1/7 weeks. She delivers a healthy baby smoothly. CONCLUSION: Antenatal sonography is an important tool to evaluate the fetus status. Under special condition, term pregnancy is still possible without any treatment. CASE REPORT: Twin reversed arterial perfusion syndrome in a monochorionic monoamniotic twin pregnancy.

Nearly half of all severe fetal anomalies can be detected by first-trimester screening in experts' hands.

Objective To evaluate the detection rate of severe fetal anomalies at the first-trimester screening (FTS) and, vice versa, to evaluate the follow-up of pathological results at FTS at the time of mid-trimester screening (MTS) and throughout pregnancy and delivery in a partially selected population of low-risk pregnancies. Methods We conducted a prospective study on the detection of severe fetal anomalies at routine FTS in 9891 pregnant women with 10,294 fetuses between 11 + 0 and 13 + 6 weeks of gestation. The findings of FTS were compared to the results of MTS and pregnancy and neonatal outcomes. Only cases with severe fetal anomalies were taken for statistical analysis in this study. Results There were 232 cases of fetal anomaly altogether. At the time of FTS, sonographic anomalies were diagnosed in 113 cases and further ultrasound controls arranged. In four cases, fetal anomaly was not confirmed by MTS; in the remaining 109 cases, the sonographic anomaly seen at FTS was confirmed at MTS and in the course of pregnancy with a resulting sensitivity for fetal malformation at FTS of 47.8%, a specificity of 99.96%, a positive predictive value of 96.5% and a negative predictive value of 98.8%. Conclusion FTS can detect almost half of all severe fetal anomalies at an early stage of pregnancy with positive predictive values of 90% and more. Sensitivities varied depending on the organ system and reached the highest figures for anomalies of the heart, the abdomen, the spine and the skeletal system.

A case of craniopagus parasiticus: an antenatal diagnosis by ultrasound screening at 16 weeks of gestation and a literature review of recently reported cases.

Al Yaqoubi HN, Fatema N, Al Fahdi BS. A case of craniopagus parasiticus: an antenatal diagnosis by ultrasound screening at 16 weeks of gestation and a literature review of recently reported cases. Turk J Pediatr 2019; 61: 941-945. Craniopagus parasiticus (CP) is a rare type of malformation of conjoined twins, with one degenerated or underdeveloped parasite twin united at the cranium with the other fully developed twin. Only a handful of cases have been documented in the literature to date. The incidence of this rare deformity is approximately 4 to 6 out of every 10,000,000 live births. We report on a case of CP, diagnosed at 16 weeks of gestation by ultrasound screening. To the best of our knowledge, the case that we present is the first CP case that was diagnosed at such an early gestational age. The formed fetus was found to harbour complex cardiac anomalies. In view of poor prognosis of survival after delivery and upon permission from the couple, the pregnancy was terminated at 17 weeks of gestation.

An assessment of the general public's knowledge of fatal fetal anomalies.

OBJECTIVE: The objective of the study is to evaluate the general population's knowledge of fatal fetal anomaly (FFA). METHODS: Descriptive statistics were utilised to describe the data. Chi-square tests assessed associations with knowledge of FFA, termination of pregnancy (TOP) for FFA, and perinatal palliative care (PPC). RESULTS: Nine hundred seventy adults of the Irish population selected by random digit dialling with 83.9% (n = 814) agreed to partake. Only 30% could correctly define FFA with little knowledge demonstrated regarding the classification of FFA. Almost half of the respondents were unaware that medical intervention was required for survival once born. Half of respondents stated that they did not know if PPC could commence at diagnosis, once the baby reached 24 weeks or not until the baby was born alive. One in 5 had knowledge that medical follow-up after TOP for FFA was available, and a third were unaware that bereavement care was available following a TOP for FFA. CONCLUSION: This study identifies lack of accurate knowledge on FFA, its classification, diagnosis, survival, and supports available following a diagnosis of FFA among the general public. This knowledge deficit highlights the need for improved health information about FFA in antenatal education and public health campaigns to facilitate informed decision-making following a FFA diagnosis.

Parasitic rachipagus conjoined twin: case report.

A parasitic twin represents a rare developmental anomaly in which an asymmetrical, nonviable conjoined twin is attached to the host body at the time of birth. Rachipagus is among the rarest of conjoined twin subtypes and typically features a parasitic twin mass attached at the spine. Herein, the authors review the literature and describe the case of a 9-month-old girl presenting with a rachipagus parasitic twin consisting of a fully developed set of lower extremities originating from the midline upper back. After a complete workup to delineate parasite and autosite anatomy, the parasitic twin mass was successfully excised by a multidisciplinary team of surgeons, and the resulting defect was closed in a single stage.

Reliable Pregnancy Testing Before Intravenous Cyclophosphamide: A Quality Improvement Study.

BACKGROUND AND OBJECTIVE: Cyclophosphamide is a teratogenic medication used in the treatment of adolescents with autoimmune disorders. This adolescent population is sexually active, does not receive adequate contraceptive care, and is at risk for unintended pregnancy. We undertook a quality improvement initiative to improve rates of pregnancy screening before intravenous cyclophosphamide administration in our adolescent girl patients. METHODS: Data were collected from the electronic medical record. The primary outcome was completion of a urine pregnancy test before intravenous cyclophosphamide infusion in girls aged 12 to 21 years between July 2011 and June 2015. Data were reviewed quarterly and an iterative quality improvement approach was used. Interventions included staff education, electronic order set updates, and a Maintenance of Certification project. Interrupted time series analysis and multivariable mixed effects logistic regression were used to evaluate trends over time and to adjust for potential confounders. RESULTS: Thirty girls received 153 cyclophosphamide infusions during the study. Pregnancy testing before medication administration increased from 25% to 100% by study completion. Infusions in the last time period were significantly more likely to be accompanied by a pregnancy test versus those in the first time period (odds ratio: 17.7; 95% confidence interval [CI]: 3.1-101.6) after adjustment for patient age, managing service, infusion setting, and insurance type. CONCLUSIONS: Our institution achieved a significant increase in standard pregnancy screening in adolescent girls receiving intravenous cyclophosphamide. The interventions most valuable in increasing screening rates were updating electronic order sets, educating staff, and physician engagement in the Maintenance of Certification program.

[Morphologic and tomodensitometric comparative analysis of two cyclotocephalic newborns]. / Analyse morphologique et tomodensitométrique comparée de deux nouveau-nés affectés d'une cyclotocéphalie.

Two specimens of cyclotocephalic newborns, coming from museum collections, have been the subject of a comparative morphologic analysis. This one comprised an external examination and a CT scan exploration. If the craniofacial features were similar, one had a quasi-normal brain, while the second specimen displayed alobar holoprosencephaly. This observation relatively surprising is discussed in the light of current knowledge on the developmental genetics of this family of malformations.

Monoamniotic twins discordant for body stalk anomaly.

Body stalk anomaly is a rare malformation. This anomaly in monozygotic twins is extremely unusual. We describe a case of monoamniotic pregnancy discordant for body stalk anomaly diagnosed at 11 weeks. Ultrasound showed a fetus with a large anterior abdominal wall defect, anomaly of the spine and no evidence of lower extremities and other with a normal morphology. As far as our concern, only three monoamniotic pregnancies discordant for this malformation were reported. Our case represents the fourth reported monoamniotic pregnancy discordant for body stalk anomaly with diagnosis made by ultrasound and the second diagnosed in the first trimester.

[POETRYAND TERATOLOGY: LORENZO MASCHERONI'S "INVITO A LESBIA CIDONIA" IN ANATOMICAL PREPARATIONS]. / POESIA E TERATOLOGIA: L'INVITO A LESBIA CIDONIA DI LORENZO MASCHERONI NEI PREPARATI ANATOMICI.

In 1793 Lorenzo Mascheroni, appointed to the chair of Mathematics at the University of Pavia and well-known poet, wrote "L'invito di Dafni Orobiano a Lesbia Cidonia". In the poem he described the beauty of the University of Pavia and its wonders gathered in the scientific collections of the museums. From the beginning, one of the glass cases of the Museum for the History of the University of Pavia shows some of the preparations described in the Mascheroni's verses. In addition to some fossils, human teratological preparations are also exposed: they recall the verses of the poem dedicated to the description of "monstrous" preparations. However, after a detailed scientifc and historical research, the traditional association of the exposed anatomical preparations with the verses is questioned.

Bone deformities and skeletal malformations in the Roman Imperial Age.

This paper describes some cases of individuals affected by skeletal deformities resulting in "freak" appearance. The skeletal remains were found during large archaeological excavations in the Roman territory, carried out by the Special Superintendence to the Archeological Heritage of Rome in the last years, dated back to the Imperial Age. The first cases reported are referred to two growth disorders with opposite effects: a case of dwarfism and another of gigantism. The former concerns a young man from the Collatina necropolis with very short and malformed limbs, which allowed a diagnosis of acondroplasic dwarfism, a rare congenital disorder that limits height below 130 cm. The latter case comes from the necropolis of Torre Serpentana in Fidenae, and is instead referred to a young person of very high stature, about 204 cm, suffering from Gigantism, a rare condition which in this case seems to have been linked to a hormonal dysfunction due to a pituitary adenoma. A third case regards a joint disease affecting the vertebral column and causing severe deformities. The skeleton was found in the Collatina necropolis and belongs to an old woman, suffering from ankylosing spondylitis. Finally, the last and very peculiar case is related to an individual recovered in the necropolis of Castel Malnome. The skeletal remains belong to an adult man with a complete fusion of the temporo-mandibular joint, which compromised mastication and caused severe deformation of the maxillofacial complex. These cases are described in detail together with the possible implications that these deformities could have on in the social context.

The birth of a monstrous child throughout history: the example of anencephaly between the Egyptian New Empire and the 21st century.

Anencephaly is of special interest for the historical study of human behaviour after the birth of a monstrous child. Examples of anencephalic human births from Egyptian Antiquity to the present time allow us to create a history of teratology, revealing hiatuses in the medical and scientific interpretation of monstrosity that contrast to a relative continuity in the imaginary processes that accompany the birth of a monstrous child.

Medieval monsters, in theory and practice.

The past two decades have witnessed a plethora of studies on the medieval monster. These studies have contributed significantly to our understanding of religion, art, literature, and science in the Middle Ages. However, a tendency to treat the medieval monster in purely symbolic and psychological terms ignores the lived experiences of impaired medieval people and their culture's attitudes toward them. With the aid of recent insights provided by disability studies, this article aims to confront "real" medieval monsters--e.g., physically impaired human beings--in both their human and monstrous aspects.

Leonardo Da Vinci, the genius and the monsters. Casual encounters?

This article analyses Leonardo's interest in monsters and deformed reality, one of the lesser known aspects of his vast and multifaceted output. With the possible exception of his studies of physiognomy, relevant drawings, sketches and short stories represent a marginal aspect of his work, but they are nevertheless significant for historians of teratology. The purpose of this study is to provide a broad overview of the relationship between Leonardo and both the literature on mythological monsters and the reports on monstrous births that he either read about or witnessed personally. While aspects of his appreciation and attention to beauty and the pursuit of perfection and good proportions are the elements most emphasised in Leonardo's work, other no less interesting aspects related to deformity have been considered of marginal importance. My analysis will demonstrate that Leonardo approached the realm of monstrosity as if he considered abnormality a mirror of normality, deformity a mirror of harmony, and disease a mirror of health, as if to emphasise that, ultimately, it is the monster that gives the world the gift of normality. Two special cases of monstrosity are analysed: the famous monster of Ravenna, whose image was found among his papers, and a very rare case of parasitic conjoined twins (thoracopagus parasiticus) portrayed for the first time alive, probably in Florence, by Leonardo himself.

The woman who gave birth to a dog Monstrosity and bestiality in Quaestiones Medico-Legales by Paolo Zacchia.

The Italian Paolo Zacchia (1584-1659) is considered one of the fathers of forensic medicine. From a letter sent by the physician and botanist Pietro Castelli, the article seeks to reconstruct the opinions that Zacchia expressed about monsters in his monumental Quaestiones Medico-Legales. Although he did not seem too sure about the possibility that a hybrid could be born from the union of a man and a beast, he believed that God intervened, allowing the birth so that the abomination could be discovered. The opinion of Zacchia is related to the image that people had at the time of the relationship between humans and animals.

"Monstre". Etienne Geoffroy Saint-Hilaire and the science of monstrosity.

This article aims at analyzing the entry "Monstre", written by Etienne Geoffroy Saint-Hilaire in 1827 and included in the Dictionnaire classique d'histoire naturelle. Under Etienne Geoffroy the study of monsters brought new heuristic and theoretical approaches to the research fields of anatomy and embryology, and acquired the status of a scientific discipline having its own theoreticalfoundations and therefore its own standards for classification, seen as non-random means for revealing a groundbreaking knowledge.

Semantics of monstrosity in the ninenteenth century.

The emphasis of the normal, the human aspect and feature in monstrosities is a leitmotif that becomes prevalent in the scientific debate on teratological phenomena in the nineteenth century. The discourse highlights the organisation of the civilising process with regard to creating an antithesis between human and animality. In this respect, anthropology establishes anthropometry as a measuring and classifying instrument, hence supporting concepts of norm and abnormity in the scientific discussion. The classification approach finally translates teratological occurrences into the "human system" with the monstrosity being transformed into a subject of knowledge. Scientific discourse poses and installs the latter as living attraction for medical and anthropological examination, thus stressing boundary permeability between man and animal. Evolutionary theory finally initiates the quest for the missing link between man and ape, with congenital disorders, such as microcephaly, becoming particularly supportive of the idea of a manifesting existence of a primitive pre-human form.