Overview
Conjoined twins are two babies who are born physically connected to each other. They develop when an early embryo only partially separates to form two individuals. Most often, they are connected at the chest, abdomen, or pelvis, and may share one or more internal body organs. Conjoined twins may be either identical (monozygotic) or non-identical (dizygotic), depending on their genetic makeup. The success of surgical separation depends on factors such as where the twins are joined and the experience and skill of the surgical team.
Understanding the disease
Development
Conjoined twins develop when a single fertilized egg splits and develops into two individuals, but the process of separation doesn't complete before it is supposed to. This usually occurs between 13 and 15 days after conception. As a result, the twins remain physically connected, most often at the chest, abdomen, or pelvis, and may share one or more internal body organs. There are different ways conjoined twins can be joined. The most common site of connection is the chest, where twins are face to face, sharing a heart and other organs. Other types of conjoined twins include thoracopagus (chest joined), omphalopagus (navel joined), hipopagus (lower abdomen joined), and cephalopagus (head joined). The type of conjoined twin and the organs shared depend on how the embryo splits and develops. In some cases, an alternative theory suggests that two separate embryos may somehow fuse together in early development, leading to the formation of conjoined twins.
Assessment and Diagnosis
Triage
You should see a doctor if conjoined twins are suspected during pregnancy. Early prenatal care is crucial for monitoring the health of both the mother and the developing babies. An ultrasound can confirm the presence of conjoined twins and provide information on the location and extent of the physical connection. A healthcare professional experienced in managing high-risk pregnancies should be consulted to assess the specific situation and discuss potential complications, treatment options, and the best course of action.
Diagnosis
Conjoined twins can be diagnosed using routine ultrasound as early as 7 to 12 weeks of pregnancy. More-detailed ultrasounds and tests that use sound waves to produce images of the babies' hearts (echocardiograms) can be used about halfway through pregnancy. If an ultrasound detects conjoined twins, a magnetic resonance imaging (MRI) scan may be done to provide greater detail about the twins' connection and shared organs. After birth, other tests are done to help identify the body structure and organ function of each twin and what is shared.
Management and Treatment
Complications
Potential complications of conjoined twins include premature birth, stillbirth or death shortly after birth, severe health issues such as trouble breathing or heart problems, and long-term health issues like scoliosis, cerebral palsy, or learning disabilities. Complications depend on where the twins are joined, which organs or body parts they share, and the expertise and experience of the healthcare team. It is essential for the family and the healthcare team to discuss the possible complications and how to prepare for them.
Treatment
Treatment of conjoined twins depends on their unique situation, which includes their health issues, where they're joined, whether they share organs or other vital structures, and other possible complications. A team of specialists, including pediatric surgeons, urologists, orthopedic surgeons, cardiologists, cardiovascular surgeons, and neonatologists, will create a treatment plan tailored to the specific needs of the twins. In some cases, medical comfort care may be provided, with a focus on nutrition, fluids, human touch, and pain relief.
Preparing for medical consultation
To prepare for an appointment for conjoined twins, consider the following steps:
- Bring a family member or friend for support.
- Prepare a list of questions to ask the healthcare provider, prioritizing them according to importance.
- Some basic questions to include are:
- What tests do my twins need?
- Where are my twins joined, and what body organs do they share?
- What is the best treatment plan?
- Is separation an option? What is the likely outcome with separation?
- How many separation surgeries have you and your team performed, and how does that compare with the national success rate?
- What are the alternatives to the suggested treatment approach?
- What specialists should be involved in the healthcare team?
- Are there any other specialists I should meet with?
- Where can I find support for my family?
- Are there printed materials I can have? What websites do you recommend?
- If I choose to have more children, is there a chance they may also be conjoined?
- Don't hesitate to ask additional questions during the appointment. Remember, the healthcare team will work together to gather information about your twins' body structures, functional capabilities, and likely outcomes to create an appropriate treatment plan. A C-section is typically planned ahead of time, usually 3-4 weeks before the due date. After the birth of the twins, they will be fully evaluated to guide decisions regarding their care and any potential separation surgery.