Description

Conjoined twins are two babies who are born physically connected to each other.

Conjoined twins develop when an early embryo only partially separates to form two individuals. Despite the fact that two of the babies will develop from this embryo, they remain physically connected-most often at the chest, the abdomen or the pelvis. Conjoined twins may also share one or more internal organs of the body.

Despite the fact that many of the siamese twins are not alive at the time of birth (stillborn) or die shortly after birth, advances in surgery and technology have improved rates of survival. Some surviving conjoined twins can be separated surgically. The success of the surgery depends on where the twins are joined and how many and which organs are shared. It also depends upon the experience and skill of the surgical team.

Symptoms

There are No specific symptoms that indicate a set twin pregnancy. As with other twin pregnancies, the uterus may grow faster than with a single baby. And be no more tiredness, nausea and vomiting in early pregnancy. Conjoined twins can be diagnosed early in the pregnancy with an ultrasound.

How twins are joined

Conjoined twins are typically classified according to where they're joined. Twins share sometimes with organs or other parts of their bodies. Each pair of conjoined twins is unique.

Conjoined twins can join any of these sites:

  • Chest. Thoracopagus (thor-uh-KOP-uh-gus), the twins are joined face-to-face in the chest. Often, they share the heart and you can also share a liver and the upper intestine. This is one of the most common sites of conjoined twins.
  • Abdomen. Omphalopagus (om-fuh-LOP-uh-gus), the twins are joined near the belly button. Many omphalopagus twins share the liver and part of the upper part of the digestive system (gastrointestinal or GI) tract. Some of the twins share the lower part of the small intestine (ileum) and the longest part of the large intestine (colon). They usually do not share a heart.
  • The Base of the spine. Pygopagus (foot-GOP-uh-gus), the twins are most commonly joined together again to return to the base of the spine and buttocks. Some pygopagus twins share the bottom of the gastrointestinal (GI) tract. A pair of identical twins share the genital and urinary organs.
  • The length of the spine. Rachipagus (ray-KIP-uh-gus), also called rachiopagus (ray-kee-OP-uh-gus), the twins are together again to go back along the length of the spine. This type is very rare.
  • The Pelvis. Ischiopagus (is-kee-OP-uh-gus), the twins are joined at the pelvis, either face-to-face or end-to-end. Many ischiopagus twins share the lower GI tract, as well as the liver and the genital and urinary organs. Each twin can have two legs, or, less commonly, the twins share two or three legs.
  • The trunk. Parapagus (pa-RAP-uh-gus), the twins are joined side-to-side in the pelvis, and the whole or part of the tummy (abdomen) and the chest, but with different heads. The twins can have two, three or four arms, and two or three legs.
  • Head. Craniopagus (kray-nee-OP-uh-gus), the twins are joined at the rear, top or side of the head but not the face. Craniopagus twins share a portion of the skull. But their brains are separated, even though they may share some of the brain tissue.
  • The head and the chest. Cephalopagus (sef-uh-LOP-uh-gus), the twins are joined at the head and upper part of the body. The faces are on opposite sides of a single, shared in the head, and they share a brain. These twins rarely survive.

In rare cases, twins can be in conjunction with one of the twins smaller and less fully formed than the other (asymmetric conjoined twins). In extremely rare cases, one of the twins can be found partially developed in the other twin (fetus in fetu).

Causes

Identical twins (monozygotic) occur when a single fertilized egg splits and develops into two individuals. Eight to 12 days after conception, the embryo of the layers in that it divides to form monozygotic twins start to develop in certain organs and structures.

It is believed that when the embryo divides after this period of time — usually between 13 and 15 days after conception — the separation stops before the process is complete. The result of siamese twins.

An alternative theory suggests that two separate embryos may in any way fuse early in development.

What could cause the chain of events is unknown.

Risk factors

Because the siamese twins are so rare, and the cause is not clear, it is not known which can make some of the couples most likely to be siamese twins.

Complications

Pregnancy with conjoined twins is complex and it considerably increases the risk of serious complications. In addition to the infants require surgical delivery by caesarean section (c-section).

As with the twins, together with the baby are likely to be born prematurely, and one or both might be dead or die shortly after birth. Serious health problems for the twins can occur immediately, such as difficulty breathing or heart problems. Later in life, health problems, such as scoliosis, cerebral palsy or learning disabilities may occur.

Possible complications depend on where the twins are joined, organs or other parts of the body they share, and with the expertise and experience of the health care team. When conjoined twins are expected, the family and the medical equipment necessary to discuss in detail the possible complications and how to prepare for them.

Diagnosis

Conjoined twins can be diagnosed by routine ultrasound at 7 to 12 weeks of pregnancy. In more detail ultrasounds and tests that use sound waves to produce images of the babies' heart (echocardiogram) may be used in approximately half of the pregnancy. These tests can help determine the scope of the twins of the connection and the functioning of their organs.

If an ultrasound detects the siamese twins, a magnetic resonance imaging (MRI) can be done. Magnetic resonance imaging can provide more detail about the siamese twins are connected and the organs they share. Fetal MRI and fetal echocardiography to help with the planning of the care during and after pregnancy. After birth, other tests are performed to help identify the body of the structure and function of the organs of each twin and what is shared.

Treatment

The treatment of the siamese depends on your particular situation — your health problems, where they're joined, if they share organs, or other vital structures, and other possible complications.

Follow-up during pregnancy

If you're carrying conjoined twins, it is likely to be closely monitored throughout the pregnancy. Probably refers to a maternal and fetal medicine specialist in high-risk pregnancies. When necessary, can also be referred to other pediatric specialists in:

  • Surgery (pediatric surgeon)
  • The urinary system, such as the kidneys and the bladder (pediatric urologist)
  • Of bone and joint surgery (pediatric orthopaedic surgeon)
  • The surgical repair and correction (plastic and reconstructive surgeon)
  • Heart and blood vessels (pediatric cardiologist)
  • Heart and blood vessel (cardiovascular surgery pediatric surgeon)
  • The care of newborn infants (neonatologist)

Their specialists and others on your health care team to learn as much as possible about your twins. This includes learning about their body structures, their ability to perform certain activities (functional capacity) and the likely outcome (prognosis) to form a treatment plan for your twins.

Delivery

A cesarean section is planned ahead of time, often 3 to 4 weeks before your due date.

After his siamese born, are fully evaluated. With this information, you and your healthcare team can make decisions related to their care and whether the separation of the surgery is appropriate.

The separation of the surgery

If the decision was made to separate the twins, the separation of the surgery is usually performed around 6 to 12 months after delivery to allow time for planning and preparation. Sometimes an emergency separation may be necessary if one of the twins dies, it develops a life-threatening condition, or a threat to the survival of the other twin.

Many complex factors that must be considered as part of the decision of the separation of the surgery. Each set of conjoined twins presents a unique set of problems due to the differences in the structure of the body and its function. Topics include:

  • If the twins share vital organs such as the heart
  • If the twins are healthy enough to withstand the separation of the surgery
  • The probability of success of the separation
  • The type and extent of surgery necessary for each twin after separation
  • Type and degree of functional support required after the separation
  • What are the challenges to the twins in the face if they remain united

Recent advances in imaging before his birth, intensive care and anesthesia care have improved the results in the separation of the surgery. After the separation of the surgery, pediatrics, rehabilitation services are crucial to help the twins to develop properly. The services may include physical, occupational, and speech therapies and other assistance as needed.

If surgery is not an option

If the separation of the surgery is not possible or if you decide not to have the surgery done, your computer can help you to meet the health care needs of their twins.

If the circumstances are serious, palliative care physicians — such as nutrition, fluids, human contact and the relief of pain — is provided.

Coping and support

Learning to be born, the twins have an important medical problem or life-threatening condition, it can be devastating. As a parent, you struggle with hard decisions to their conjoined twins and the future uncertain. The results can be difficult to determine, and the siamese twins who survive often face enormous obstacles.

Because the siamese twins are rare, it can be difficult to find support resources. Ask your health care team if the medical social workers, and counselors are available to help. Depending on your needs, ask for information on organizations that support parents who have children with physical conditions that limit their ability or who have lost their children.

Preparing for your appointment

If you're pregnant with twins siamese, you will be referred to a team of specialists to help guide you to create a treatment plan for your twins. Here's some information to help you prepare and what to expect from your computer.

What you can do

Before your appointment:

  • Consider the possibility of a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who comes with you may remember something that you missed or forgot.
  • Make a list of questions to ask your health care provider. A list of questions from most to least important to make the most of your appointment time.

Some basic questions to ask include:

  • What evidence do my twins need?
  • Where are my twins are joined and, in his case, the organs of the body do they share?
  • What is the best treatment plan?
  • Is the separation of an option? What is the most likely outcome, with a separation?
  • How many of separation of the surgeries have you and your team perform, and how many have been successful? How does it compare with the national, the success rate?
  • What are the alternatives to the treatment approach that you're suggesting?
  • What specialists should be involved in the health care team?
  • There are other specialists who should I meet with?
  • Where can I find support for my family?
  • There is printed material I can have? What sites do you recommend?
  • If I choose to have more children, there is a possibility that they, too, can be a siamese?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your health care provider and other members of your health care team will review your twins siamese tests and the results of the tests and discuss the options with you. Together with your team, you can make decisions for your twins to treatment and care.

Symptoms and treatment of Conjoined twins