Vous êtes sur la page 1sur 2

Available online at

www.pharmscidirect.com
Int J Pharm Biomed Res 2013, 4(3), 187-188

International Journal
of PHARMACEUTICAL
AND BIOMEDICAL
RESEARCH
ISSN No: 0976-0350

Case report

Conjoined twins: A rare case report


N.Deepika1*, Arun Kumar2
1
2

Department of Obstetrics and Gynaecology, Sri Devaraj Urs Medical college, Tamaka, Kolar-563 101, Karnataka, India
Department of Obstetrics and Gynaecology, Indira Gandhi Medical College, Shimla-171 001, Himachal Pradesh, India

Received: 15 Aug 2013 / Revised: 23 Aug 2013 / Accepted: 25 Aug 2013 / Online publication: 02 Sep 2013

ABSTRACT
Conjoined twin is a rare occurance in obstetric practice. In the present case study, we are reporting one case of
cranithoracophagus conjoined twins. A 30 year old women unbooked gravida 3 para 2 living 2 reported to antenatal OPD for
routine antentatal check up. Obstetric scan was done which revealed twin pregnancy, monochorionic monoamniotic
conjoined twin of 26 weeks 5 days. The separation of conjoined twins is associated with increased chance of perinatal
mortality. Therefore, making an early diagnosis with ultrasonographic examination provides the parents a chance to opt for
pregnancy termination.
Key words: Conjoined twins, Craniothoracophagus

1. INTRODUCTION
Twins is not an uncommon phenomenon but conjoined
twins are indeed a rarity, since the event occurs only once in
50,00060,000 births [1]. If twinning is initiated after the
embryonic disc and amniotic sac have formed and if the
division of the embryonic disc is incomplete, conjoined twins
result [2]. Approximately 40-60% of conjoined twins arrive
stillborn, and about 35% survive only one day. The overall
survival rate of conjoined twins is somewhere between 5 and
25%.
We report a rare case of conjoined twins who presented
recently in our department.
2. CASE REPORT
A 30 year old women unbooked gravida 3 para 2 living 2
reported to antenatal OPD for routine antentatal check up.
Her LMP was 26.08.2011 and her period of gestation was 28
weeks 3 days.

*Corresponding Author. Tel: +91 9916054700


Email: deepikang@gmail.com

Fax:

2013 PharmSciDirect Publications. All rights reserved.

Obstetric history:
First child was FTND of female baby at a government
hospital, baby 5 years old, alive and healthy. Second
pregnancy was FTND of female baby at government hospital,
baby 2 years old, alive and healthy. There was no history of
twinning in the family. On her examination, she was average
built and nourished. Her general physical and systemic
examination was normal. Obstetrical examination: fundal
height was 32 weeks, fetal parts were palpable and exact
presentation could not be made out.
Investigations:
Hb 10.8g%, blood group O+ve, urine examination was
normal. Obstetric scan was done which revealed twin
pregnancy, monochorionic monoamniotic conjoined twin of
26 weeks 5 days. Presentation was cephalic, placenta fundal,
AFI of 16-17cm, fetal heart of both twins present and there
was fusion of head, chest and abdomen of both fetuses. The
patient and her relatives were counselled about the
incompatibility of life and after arranging blood she was
induced with 50g of misoprostol, 2 doses 6 hours apart. She
had vaginal delivery of twin female babies which were still
born and weighed 2.4kg (Fig.1). The baby had four arms,
four legs, one head and chest and abdomen was fused (Fig.2).
The placenta was single and weighed 650g. Third stage was
uneventful.

N.Deepika and Arun Kumar, Int J Pharm Biomed Res 2013, 4(3), 187-188

Fig 1: Cranithoracophagus conjoined twins

188

approximately 13-15 days postovulation. Most conjoined


twins are female, with the ratio of women to men being
reported as 2:1 or 3:1. Many of these infants are delivered
prematurely and are stillborn. They are classified according
to their site of union. The most common location is the chest
(thoracopagus), followed by the anterior abdominal wall from
the xiphoid to the umbilicus (xiphopagus), the buttocks
(pygopagus), the ischium (ischiopagus), and the head
(craniopagus) [3]. Organs may be shared to varying degrees
in different sets of twins. Major congenital anomalies of one
or both twins are not uncommon. Polyhydramnios is said to
be present in almost one half of the reported cases of
conjoined twins. Antenatal diagnosis by ultrasound is
possible in modern day obstetrics. Ultrasonographic
identification of any of the following classical signs may
suggest the diagnosis: both fetal heads in the same plane,
unusual backward flexion of the cervical spine, no change in
the relative position after maternal movement and manual
manipulations and inability to separate fetal bodies after
careful observation [4].
Caesarean delivery near term is the preferred method of
delivery to minimize maternal and fetal injury. If the twins
are thought to have a poor chance of surviving and are small
enough to pass through the birth canal without damaging the
mother, vaginal delivery might be considered.
Separation of conjoined twins is complicated procedure.
The importance of multidiscipline team with rehearsal of all
aspects (surgical, anaesthetic and nursing) of the operative
procedure cannot be overemphasized. Although the outcome
is influenced by careful planning and organization from all
participants, the prognosis is often predetermined by the
underlying anatomy which may preclude successful
separation [5].
4. CONCLUSION

Fig 2: X-ray of the conjoined twins

The separation of conjoined twins is associated with


increased chance of perinatal mortality. Therefore, making an
early diagnosis with ultrasonographic examination provides
the parents a chance to opt for pregnancy termination.
REFERENCES

3. DISCUSSION
Conjoined twins occur with a frequency of about 1 per
50,000 deliveries and are an extremely rare complication of
monochorionic twinning. The precise etiology of conjoined
twinning is unknown, but the most widely accepted theory is
that incomplete division of a monozygotic embryo occurs at

[1] Tan, K.L., Goon, S.M., Salmon, Y., Wee, J.H., Acta Obstet Gynecol
Scand 1971, 50, 373-380.
[2] Cunningham, F.G., MacDonald, P.C., Gant, N.F., Williams Obstetrics,
21st Edn. McGraw-Hill, New York 2003.
[3] Malone, F.D., DAlton, M.E., Clin Perinatol 2000, 27, 1033-1046.
[4] Kalchbrenner, M., Weiner, S., Templeton, J., Losure, T.A., J Clin
Ultrasound 1987, 15, 59-63.
[5] Miller, D., Colobani, P., Buck, J.R., Dudgeon, D.L., Haller, J.A., J Ped
Surg 1983, 18, 373-376.