 Hello everyone. This is Dr. Jagannatham. I'm doing my third year post-graduation in BGMC, I'm here to present a case of a congenital twins. Most interesting congenital malformation is a congenital twin. Congenital twins are rare occurrence. They are known as SAMS twins. After first SAMS twins exhibited in America in 1829. And these twins were born in Thailand. So they named it SAMS twins. So we present a case report of congenital twins and ultrasound and color Doppler techniques were used, which were performed in a Samsung CVT-USG machine. And the patient is a 18-year-old primary editor, presented with history of five months of memory to the Oxford department. And she was referred to the radiology department for second term with the cancer to exclude any fetal phenomena. And we performed the USG and following findings were there. Both fetals appear to be fused at lower abdomen and pelvis on ventral aspect. And both thoracic cavities appear separate. Both heads were separate. And the process of fusion began at the level of liver. Liver of twins appears to be fused, but the stomach bubbles appear separate. And there is single umbilical cord. They say in supplying twins. And three lower limbs could be appreciated. And two of them appear to be fused with short and femur and tibia. And there is single bladder bubble. So on the basis of the findings, the diagnosis of ischopagus congenital twins was denied. Because in most commonly the lower limb anomalies are associated ischopagus congenital twins. And the parents were informed about the malformation. And the twins were censored for survival. And stimulation of pregnancy was done. And gross specimen analysis showed single male external genitalia in addition to the upper mental findings. So these are the pictures. In this first picture, we can see both heads facing each other with anterior placenta. And in the second picture shows a separate thoracic cavities with separate heart and both spine facing each other. Then here it is at the level of liver where the fusion has occurred. And this is only single, this picture shows a single bladder bubble. And this is color Doppler analysis of umbilical cord. These two are the continuous sections which shows that both the fetus are supplied with single umbilical cord. And this is the gross specimen after medical termination of pregnancy. There is single umbilical cord. And there is fusion and the pelvis on the mental aspect. And there is single external male genitalia. So moving on to discussion. Convined twins are rare except prevalence is not known. The estimated prevalence is 1 in 50,000 for 1 in 2 lbs. And there is a female predominance of the order of 3 is 1. The convalent twinning process occurs when the division of embryonic disc occurs more than 14 days after fetal division. In after 14 days of fetalization, there is incomplete division which results in consenting. So this incomplete division is more severe when it occurs in the later stage. So later the division, the more severe the effect. So duplicata incompleta is the most severe form of incomplete division because division is so late and incomplete. And only a few organs is sometimes duplicate. So when this twin has matured, the postnatally the surgical division becomes impossible and it poses a great challenge to her. So classification of consenting, it is dependent on the basis of the part fuse. So when thorax is fused, thoracophagus, in case of the monoplapegas, in case of sacrum, it is pygophagus, and pelvis is fused fagus. When skull is fused, it is craniofagus, and when pelvis is fused, it is aplophagus. And when both back are fused, it is called rectifagus. And parafagus is the fusion of ventrolateral lutea. So this is the occurrence. Forty percent most of the consent wins or thoracophagus, that is 40 percent. The next comes omphlapegas and pygophagus and ischiofagus, which is six percent. So this is the pictorial representation of consent wins. And this is thoracophagus, this is omphlapegas, and pygophagus. This is ischiofagus. And craniofagus, parafagus, that is ventrolateral area fusion. And this is cephalophagus. And this is rectifagus, that is the fusion of the ventrolateral area. So diagnostic criteria on USG, in the first time I said, there will be a biped appearance of the fetal pole, which is useful to diagnose the conjunctin. And when the baby may choose, we can demonstrate a continuous non-separated external skin contact with conjunct body parts, and body parts of the twin are imaged on the same level, and in the same phone or play. And no changes related to the twins to one another, and non-subsistence. Monochorionic twinning will be there. There is single pleasantal mass and no interaction number. And more than three vessels can be visualized in a single omni-tropacic. And there will be associated complex multiple fetal anomalies. So finally, the prognosis. Usually the prognosis of consent wins is unfavorable. Approximately 40 percent cases are still bound. So what's prognosis is concerned with craniofagus, and those with the sole cardiac mass, that is thoracophagus. So structural moments are frequently found, such as polyhydromia, cardiac malformation, and omphalosis, and neural tube defect. When congenital twins are diagnosed in person's second trimester, uterination of pregnancy should therefore be recommended, due to its over-prognosis. But if the patient presented in late trimester with congenital twins further induces such as MRI, fetal MRI, is to be planned to accurately define anatomic fusion, bascalar anomalies, and other associated abnormalities, which is important for surgical planning and prognostic information, and which will help the pediatric surgeon to plan surgery. Thank you.