Fetus in fetu (or foetus in foetu) is a rare developmental abnormality in which a mass of tissue resembling a fetus forms inside the body of its twin. An early example of the phenomenon was described in 1808 by George William Young. [1]
There are two hypotheses for the origin of a fetus in fetu. One hypothesis is that the mass begins as a normal fetus but becomes enveloped inside its twin. [2] The other hypothesis is that the mass is a highly developed teratoma. Fetus in fetu is estimated to occur in 1 in 500,000 live births. [3]
A fetus in fetu can be considered alive, but only in the sense that its component tissues have not yet died or been eliminated. Thus, the life of a fetus in fetu is akin to that of a tumor in that its cells remain viable by way of normal metabolic activity. However, without the gestational conditions in utero with the amnion and placenta, a fetus in fetu can develop into, at best, an especially well differentiated teratoma; or, at worst, a high-grade metastatic teratocarcinoma. In terms of physical maturation, its organs have a working blood supply from the host, but all cases of fetus in fetu present critical defects, such as no functional brain, heart, lungs, gastrointestinal tract, or urinary tract. Accordingly, while a fetus in fetu can share select morphological features with a normal fetus, it has no prospect of any life outside of the host twin. Moreover, it poses clear threats to the life of the host twin on whom its own life depends. [4]
There are two main hypotheses about the development of fetus in fetu.
Fetus in fetu may be a very highly differentiated form of dermoid cyst, itself a highly differentiated form of mature teratoma. [5]
Fetus in fetu may be a parasitic twin fetus growing within its host twin. Very early in a monozygotic twin pregnancy, in which both fetuses share a common placenta, one fetus wraps around and envelops the other. The enveloped twin becomes a parasite, in that its survival depends on the survival of the host twin, by drawing on the host twin's blood supply. The parasitic twin is anencephalic (without a brain) and lacks some internal organs, and as such is unable to survive on its own. As the host twin has to "feed" the enveloped twin from the nutrients received over a single umbilical cord, they usually die before birth.[ citation needed ]
The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional layer thickens and then is shed during menstruation in humans and some other mammals, including other apes, Old World monkeys, some species of bat, the elephant shrew and the Cairo spiny mouse. In most other mammals, the endometrium is reabsorbed in the estrous cycle. During pregnancy, the glands and blood vessels in the endometrium further increase in size and number. Vascular spaces fuse and become interconnected, forming the placenta, which supplies oxygen and nutrition to the embryo and fetus. The speculated presence of an endometrial microbiota has been argued against.
The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate maternal and fetal circulations, and is an important endocrine organ, producing hormones that regulate both maternal and fetal physiology during pregnancy. The placenta connects to the fetus via the umbilical cord, and on the opposite aspect to the maternal uterus in a species-dependent manner. In humans, a thin layer of maternal decidual (endometrial) tissue comes away with the placenta when it is expelled from the uterus following birth. Placentas are a defining characteristic of placental mammals, but are also found in marsupials and some non-mammals with varying levels of development.
Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can often result in the feeling of guilt or grief in the mother. The term is in contrast to miscarriage, which is an early pregnancy loss, and sudden infant death syndrome, where the baby dies a short time after being born alive.
A teratoma is a tumor made up of several types of tissue, such as hair, muscle, teeth, or bone. Teratomata typically form in the tailbone, ovary, or testicle.
In animals, viviparity is development of the embryo inside the body of the mother, with the maternal circulation providing for the metabolic needs of the embryo's development, until the mother gives birth to a fully or partially developed juvenile that is at least metabolically independent. This is opposed to oviparity, where the embryos develop independently outside the mother in eggs until they are developed enough to break out as hatchlings; and ovoviviparity, where the embryos are developed in eggs that remain carried inside the mother's body until the hatchlings emerge from the mother as juveniles, similar to a live birth.
Craniopagus parasiticus is an extremely rare type of parasitic twinning occurring in about 4 to 6 of 10,000,000 births. In craniopagus parasiticus, a parasitic twin head with an undeveloped body is attached to the head of a developed twin. Fewer than a dozen cases of this type of conjoined twin have been documented in literature.
A parasitic twin, also known as an asymmetrical twin or unequal conjoined twin, occurs when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of the other. It results from the same processes that also produces vanishing twins and conjoined twins, and may represent a continuum between the two. In parasitic twins, one ceases development during gestation and is vestigial to a mostly fully formed, otherwise healthy individual twin. The undeveloped twin is termed as parasitic, because it is incompletely formed or wholly dependent on the body functions of the complete fetus. The independent twin is called the autosite.
Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm. There are two clinical varieties of polyhydramnios: chronic polyhydramnios where excess amniotic fluid accumulates gradually, and acute polyhydramnios where excess amniotic fluid collects rapidly.
Twin-to-twin transfusion syndrome (TTTS), also known as feto-fetal transfusion syndrome (FFTS), twin oligohydramnios-polyhydramnios sequence (TOPS) and stuck twin syndrome, is a complication of monochorionic multiple pregnancies in which there is disproportionate blood supply between the fetuses. This leads to unequal levels of amniotic fluid between each fetus and usually leads to death of the undersupplied twin and, without treatment, usually death or a range of birth defects or disabilities for a surviving twin, such as underdeveloped, damaged or missing limbs, digits or organs, especially cerebral palsy.
The EXIT procedure, or ex utero intrapartum treatment procedure, is a specialized surgical delivery procedure used to deliver babies who have airway compression. Causes of airway compression in newborn babies result from a number of rare congenital disorders, including bronchopulmonary sequestration, congenital cystic adenomatoid malformation, mouth or neck tumor such as teratoma, and lung or pleural tumor such as pleuropulmonary blastoma. Airway compression discovered at birth is a medical emergency. In many cases, however, the airway compression is discovered during prenatal ultrasound exams, permitting time to plan a safe delivery using the EXIT procedure or other means.
A vestigial twin is a form of parasitic twinning, where the parasitic "twin" is so malformed and incomplete that it typically consists entirely of extra limbs or organs. It also can be a complete living being trapped inside the host person, however the parasitic twin is anencephalic and lacks consciousness.
Campylobacter fetus is a rod-shaped, gram-negative species of bacteria within the genus Campylobacter of phylum Pseudomonadota. Identification of C. fetus species in infected animals or people is routinely performed by culture on blood or cefoperazone deoxycholate agar. Subspecies of C. fetus commonly causes reproductive disease in ruminants and gastrointestinal disease in humans. Transmission of C. fetus subspecies venerealis occurs mainly through venereal contact while transmission of C. fetus subspecies fetus occurs mainly through ingestion of bacteria in a contaminated environment. Infertility in cattle and abortion in sheep are common outcomes of infection associated with C. fetus subspecies venerealis and C. fetus subspecies fetus, respectively. Disease in humans occurs through zoonotic transmission of C. fetus mainly via ingestion of contaminated food or water sources. C. fetus can be diagnosed with polymerase chain reaction assays, enzyme linked immunosorbent assays and vaginal mucus agglutination testing. As vaccines are typically not efficient in preventing future spread, infected bulls are often culled. Human infections may be treated with erythromycin as antimicrobial resistance has been emerging for the fluoroquinolones.
Multinucleate cells are eukaryotic cells that have more than one nucleus, i.e., multiple nuclei share one common cytoplasm. Mitosis in multinucleate cells can occur either in a coordinated, synchronous manner where all nuclei divide simultaneously or asynchronously where individual nuclei divide independently in time and space. Certain organisms may have a multinuclear stage of their life cycle. For example, slime molds have a vegetative, multinucleate life stage called a plasmodium.
Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture.
Twin reversed arterial perfusion sequence, also called TRAP sequence, TRAPS, or acardiac twinning, is a rare complication of monochorionic twin pregnancies. It is a severe variant of twin-to-twin transfusion syndrome (TTTS). In addition to the twins' blood systems being connected instead of independent, one twin, called the acardiac twin, TRAP fetus or acardius, is severely malformed. The heart is absent or deformed, hence the name "acardiac", as are the upper structures of the body. The other limbs may be partially present or missing, and internal structures of the torso are often poorly formed. The other twin is usually normal in appearance. The normal twin, called the pump twin, drives blood through both fetuses. It is called "reversed arterial perfusion" because in the acardiac twin the blood flows in a reversed direction.
Pulmonary hypoplasia is an incomplete development of the lungs, resulting in an abnormally low number or small size of bronchopulmonary segments or alveoli. A congenital malformation, most often occurs secondary to other fetal abnormalities that interfere with normal development of the lungs. Primary (idiopathic) pulmonary hypoplasia is rare and usually not associated with other maternal or fetal abnormalities.
Immune tolerance in pregnancy or maternal immune tolerance is the immune tolerance shown towards the fetus and placenta during pregnancy. This tolerance counters the immune response that would normally result in the rejection of something foreign in the body, as can happen in cases of spontaneous abortion. It is studied within the field of reproductive immunology.
The placental microbiome is the nonpathogenic, commensal bacteria claimed to be present in a healthy human placenta and is distinct from bacteria that cause infection and preterm birth in chorioamnionitis. Until recently, the healthy placenta was considered to be a sterile organ but now genera and species have been identified that reside in the basal layer.
Fetal programming, also known as prenatal programming, is the theory that environmental cues experienced during fetal development play a seminal role in determining health trajectories across the lifespan.
Epignathus is a rare teratoma of the oropharynx. Epignathus is a form of oropharyngeal teratoma that arises from the palate and, in most cases, results in death. The pathology is thought to be due to unorganized and uncontrolled differentiation of somatic cells leading to formation of the teratoma; sometimes it is also referred to as fetus in fetu, which is an extremely rare occurrence of an incomplete but parasitic fetus located in the body of its twin. This tumor is considered benign (non-cancerous) but life-threatening because of its atypical features and high risk of airway obstruction, which is the cause of death in 80-100% of the cases at the time of delivery.