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P368: Cervical ultrasonography at 28 to 32 weeks in twin gestation in predicting spontaneous preterm delivery

Conjoined twinning is an exceedingly rare phenomenon occurring in one in every 50 000 to 1 00 000 pregnancies. Furthermore, ectopic conjoined twinning has been sparsely reported throughout the literature. To our knowledge, there have been no reported cases of ectopic conjoined twins diagnosed by ultrasound. We present a case of a 38 year-old African-American multigravida who presented to the emergency department with sudden onset rightsided abdominal pain and a quantitative serum beta hCG of 63 000 mIU per mL. The patient’s history was significant for a postpartum tubal sterilization five years prior. After a thorough physical examination, the patient underwent a pelvic sonogram, which demonstrated a right adnexal ectopic gestational sac containing conjoined thoracopagus twins at 12 weeks’ gestational age with single cardiac motion. An MRI supported the suspected diagnosis. At the time of exploratory laparotomy, a large right ampullary ectopic pregnancy was encountered and resected. Pathologic examination confirmed that the right fallopian tube contained a 12 week conjoined twin pregnancy. Previously reported cases of ectopic conjoined twins have been diagnosed only at the time of exploratory laparotomy. This case illustrates the capability of high-resolution ultrasound to accurately make the antenatal diagnosis of an ectopic conjoined twin pregnancy.