Conjoined Siamese Twins Incidence Delivered by Caesarian Section- A Case Report

The combined twins are identical twins whose bodies are included in the uterus [1]. This is a rare event with incidents of 1 in 50,000-100,000 births. Events in Africa and Southwest Asia are somewhat more incidental [2]. The combined survival rate for connecting twins is approximately 25% [3] and this situation occurs more frequently between women, [2] with a ratio of 3:1. It is rare to see a twin-linked reaching up to term. The present case takes attention because the twin twins are very rare, given that this incidence was the first of its kind in the facility.

A 28-year-old mother at Ejura Sekyedumase District in the Ashanti region of Ghana had Siamese twins incidence conjoined in her abdomen at the Ejura government hospital. From the medical practitioners, they would need sophisticated equipment to separate the twins, adding that the conjoined twins would be referred to a tertiary health institution (Komfo Anokye Teaching Hospital) in the country as the mother’s delivery was not smooth and that they were conjoined twins so Cesarean Section had to be performed after the mother had undergone a similar surgery two years ago.

The C-section started at about 6:30pm and ended at 7pm night. And according to the medical superintendent who carried out the C-section, the conjoined twins were very rare, noting that the case was the first of its kind to be recorded at the facility but that is not the first for Dr. Manye to have carried out in the country. Five years ago, he performed a more complicated case at New Edubiase hospital in the Ashanti region. In that case, the twins shared vital organs like the heart and lung which were very delicate. However, according to the medical practictioner, the children died shortly after delivery because the scan failed to indicate they were conjoined and doctors could not have considered a C-section. The team had to perform other functions to save the life of the woman. But in this case, the mother of the Siamese twins shared her experience with the news media and that she was recovering enough to care for her children. Below is the photo image of the babies delivered by caesarian section (Figure 1 & 2).

Figure 1:

There are different types of twins shown in the following types of combinations, out of which only 60% are born alive [4,5] (Table 1).

Figure 2:

Source: Ghana|myjoyonline

Table 1:

Postpartum trips ensure that the complications of pregnancy are easily raised and rare events such as twin twins can be easily diagnosed on fetal ultrasonography. It should be suspected whenever there is a diagnosis of monochromic monoamniotic twin, fetal bodies never seen separately on regular USG, the presence of multiple vessels in umbilical cords and detection of other anomalies [6]. Once the different placentas are not seen or the intermediate film is not seen, the combined twins can be excluded. Color Doppler two-dimensional ultrasound has become an important prenatal diagnostic tool for the diagnosis of conjoined twins from 11 to 14 weeks [7,8].

The delivery of conjoined twins is the next important decision. Because obstruction is inevitable, vaginal delivery in conjoined twins is virtually impossible unless the fetus is macerated or prematurely delivered [9,10]. If the fetus is viable, they need to be delivered by caesarean section. When they are not viable, they still need caesarean section because of dystocia, unless they are very small, and then vaginal delivery may succeed [11]. The present case stands out because the patient had the siamese twins conjoined in the abdomen and the only means was by caesarian section to deliver the babies [12-14].

Siamese twins are an uncommon phenomenon and their vaginal delivery is a rare event. Prenatal care and proper care will ensure that the accidents cited in this report are averted.

The author appreciates the contributions Dr. Mensah Manye (medical superintendent) who carried out the C-section and all the nursing staff of the Ejura government hospital pediatric surgery unit in the care of these twins during the Caesarian section.

There is no conflict of interest to declare.

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12. https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Iwas- frightened-when-I-saw-my-babies-Mother-of-Siamese-twins- 659185?gallery=1
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