Having conjoined twins is an extremely rare phenomenon with an occurrence estimate ranging 1 in 49,000 births to 1 in 189,000 births. The occurrence is higher in Southeast Asia and Africa. It is defined as identical twins joined in utero.
Approximately half are stillborn, and an additional one-third die within 24 hours. Most live births are female, with a ratio of 3:1. Most stillborn are male. (Medscape 2015). Conjoined twins are born physically connected to each other. They develop when an early embryo only partially separates to form two individuals.
Although two fetuses will develop from this embryo, they will remain physically connected at the chest, abdomen or pelvis region. The twins may also share one or more internal organs. Many conjoined twins die in the womb (stillborn) or die shortly after birth. This was the case of a set of twins delivered in Plateau state specialist hospital, Jos, Plateau state. They were joined at the thorax and abdomen but with one pair of upper and lower limbs (Dicephalus twins) and weighed 1.4kg. Quite unfortunately, they didn’t survive.
Some surviving conjoined twins can be surgically separated. The success of surgery depends on where the twins are joined and how many and which organs are shared, as well as the experience and skill of the surgical team. Similarly, the treatment of conjoined twins depends on their unique circumstances which include their health, where they’re joined, and whether they share organs or other vital structures.
It isn’t in every case that a separation surgery is performed. It is an elective procedure done two to four months after birth. Sometimes an emergency separation may be needed if one of the twins dies, develops a life-threatening condition or threatens the survival of the other twin. A lot of complex factors must be considered as part of the decision to pursue separation surgery. Questions may include:
1) Do the twins share vital organs, such as the heart?
2) What are the odds of successful separation?
3)What type of reconstructive surgery might be needed for each twin after successful separation?
4) Are the twins healthy enough to withstand separation surgery?
5) What functional support will be needed after separation?
6) What issues would the twins face if left conjoined?
7) Are the twins healthy enough to withstand separation surgery?
Recent advances in prenatal imaging, critical care and anesthetic care have improved outcomes in separation surgery, however if separation surgery isn’t possible or if one decides not to pursue the surgery, your team can help you meet the medical care needs of your twins. If the circumstances are grave, medical comfort care such as nutrition, fluids, human touch and pain relief is provided.
Graphic photo (Please be warned)