Conjoined Twins

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What are Conjoined Twins?

Conjoined twins are two babies who are physically connected to each other from birth. Conjoined twins develop when an early embryo only partially separates to form two. Even though two fetuses will develop from this embryo, they will still be physically connected — most often at the chest, abdomen, or pelvis. Conjoined twins may also share one or more internal organs.

Many cases of conjoined twins are stillborn or die shortly after birth. Fortunately, nowadays advances in surgery and medical technology are able to increase the survival rate of conjoined twins.

Surgery has helped numerous cases where conjoined twins managed to survive. The success rate of surgery depends on where the twins are joined, which organs are shared, and the experience of the surgical team.

Before the surgery, consult with a pediatric surgeon first to find out the side effects and the success rate of surgery to improve the quality of life of your conjoined twins.

Causes of Conjoined Twins

Identical twins or monozygous twins occur when a single fertilized egg splits and develops into two individuals. The embryonic layers then divide to form monozygous twins which develop into specific organs and structures. This process occurs 8 to 12 days after conception.

When the embryo splits more slowly than usual, between 13 to 15 days after conception, the separation stops sooner before the process is complete. This is what causes the twins to conjoin.

Conjoined twins are considered rare cases and the cause is unknown. There is also an alternative theory which suggests that two separate embryos may somehow become fused as one at an early stage of development. Further studies are needed to determine the cause.

When to See a Doctor about Conjoined Twins 

Conjoined twins can be diagnosed through a standard ultrasound exam at the end of the first trimester. More-detailed ultrasound and echocardiogram scans can be used during mid-pregnancy to determine the extent of the twins’ connection and the function of their organs.

In addition to ultrasound, your doctor may use other technologies such as magnetic resonance imaging (MRI) to provide greater details on where the conjoined twins are connected and which organs are shared. Fetal MRI and fetal echocardiography will assist your doctor in developing a treatment plan during and after pregnancy

Symptoms of Conjoined Twins 

There are no specific signs or symptoms that indicate a conjoined twin pregnancy. As with other twin pregnancies, the uterus may grow faster than with a single fetus.

Pregnant women may experience more fatigue, nausea, and vomiting in early pregnancy. Conjoined twins can also be diagnosed using standard ultrasound exams. 

Treatment for Conjoined Twins

Treatment of conjoined twins depends on the state of the twins — their health issues, where they are joined, where the twins share organs or other vital structures, and possible complications. Below are some recommended treatment methods for conjoined twins.

Monitoring During Pregnancy

If you are carrying conjoined twins, then you should be closely supervised throughout your pregnancy. You will likely be referred to a maternal and fetal medicine specialist doctor in high-risk pregnancy. You may also be referred to other specialists, such as:

  • Pediatric surgeons
  • Pediatric urologists
  • Pediatric orthopedic surgeons
  • Plastic surgeons
  • Pediatric cardiologists
  • Pediatric cardiovascular surgeons
  • Neonatologists

Your doctor and the rest of your health care team will learn as much as possible about your conjoined twins’ anatomy, functional abilities and prognosis to form the best treatment plan for your twins.

Delivery

Your doctor usually plans a cesarean section 2 to 4 weeks before your due date. Once your conjoined twins are born, they will be fully evaluated right after.

With the help of your health care team, you may decide on what treatment is best for the twins and whether separation surgery is necessary.  

Separation Surgery

Separation surgery is an elective procedure usually performed a year or more after the conjoined twins are born. The postponed procedure is intended for careful planning and preparation. 

In some cases, an emergency separation surgery may be needed if one of the twins dies, develops a life-threatening condition or threatens the survival of the other twin. 

There are many complex factors that must be considered before deciding to undergo separation surgery. Each set of conjoined twins poses different sets of considerations, depending on their anatomy. Concerns may include: 

  • Success rate of the separation surgery
  • Whether they share vital organs, such as the heart
  • Whether they are healthy enough for separation surgery
  • What challenges will they face if left conjoined
  • Type and extent of functional support required after separation surgery.
  • Type and extent of reconstructive surgery required for each twin after separation surgery.

If separation surgery is not possible or you decide not to proceed with the procedure, your health care team will make sure that your conjoined twins meet all their medical needs and care. In case of an emergency, your health care team may already provide nutrition, fluids, and pain reliever required by you or your conjoined twins. 

Cost Estimation for Conjoined Twins Treatment 

The treatment cost for conjoined twins may vary. It is advised that you are prepared to spend more on the surgical procedure required. This includes the costs for consultations, check-ups during pregnancy, surgery, all the way to recovery.

For more details regarding the treatment cost for conjoined twins, contact Smarter Health

Prevention of Conjoined Twins

Until now, conjoined twins cannot be completely prevented. You have to identify how conjoined twins may occur and the underlying causes. Conjoined twins cannot be linked to genetics, maternal behaviors, trauma, viruses, disease and other numerous factors.

Moreover, it is also unknown how to prevent the birth of conjoined twins or monozygous twins.

Home Remedies for Conjoined Twins

Pregnancy with conjoined twins is a very complex condition and may greatly increase the risk of serious complications. Conjoined twins require a C-section delivery due to the variations of their anatomy.

Conjoined twins are likely to be born prematurely and one or both of them may still be stillborn or die shortly after birth. Potential serious health problems such as difficulty breathing or heart problems may occur. There are also problems that may arise later in life, such as scoliosis, cerebral palsy, or learning disabilities.

Possible complications depend on where the twins are connected, which organs are shared, and the skills and experience of the health care team. You, your family and the health care team need to discuss in detail about possible complications and how to prepare for them.

Have questions about conjoined twins? Write in the comment section below or you can find a local and international pediatric surgeon through Smarter Health’s teleconsultation service.

Smarter Health is ready to assist you in finding recommended health care services for you. 

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