A rare case of thoraco omphalopagus twins

Abstract

Conjoined twins, popularly referred as Siamese twins, are twins joined in utero, affecting less than 1% of the monozygotic pairs. The frequency of conjoined twins has prevalence of 1.5 in 1 lakh births and thoracopagus is the most common. Early diagnosis is important as many patients opt for termination because of the grave prognosis. Though the prognosis of conjoined twin is generally low, there is limited evidence regarding the optimum method of termination of the pregnancy particularly in advanced gestational age. We hereby, report a rare case of successful medical termination of thoraco-omphalopagus twins at 23 weeks and 2 days of gestation. A 27-years old, 2nd gravid woman with previous vaginal delivery diagnosed with conjoined thoraco-omphalopagus twin pregnancy at 23 weeks and 2 days of gestation after the detailed ultrasonographic evaluation. Proper assessment and counselling were done regarding prognosis. Different options of termination were discussed and patient opted for medical termination of pregnancy with possibility of reverting to hysterotomy in case difficulty is encountered. After a 2 day of cervical preparation, a successful vaginal delivery was conducted. Even though this is an experience from a single case, medical termination can be safely preformed in carefully selected cases of conjoined twins beyond 20 weeks of gestation. The adequate cervical preparation, pain control and careful monitoring of the procedure are critical for optimal outcome.