Conjoined twins: From conception to separation, a review

Mian, Asma; Gabra, Nader Ishak; Sharma, Tanuj; Topale, Nitsa; Gielecki, Jerzy; Tubbs, R. Shane; Loukas, Marios

doi:10.1002/ca.22839

Cited by 64 publications

(61 citation statements)

References 46 publications

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“…Anatomically, conjoined twins are classified based upon the site of attachment: thorax (thoracopagus), abdomen (omphalopagus), sacrum (pygopagus), pelvis (ischiopagus), skull (cephalopagus), and back (rachipagus). The extent of organ sharing, especially of the heart, determines the possibility and prognosis of a surgical separation procedure [ 2 ]. The most common types are thoracopagus [ 6 , 15 ] with fusion from the anterior thorax to the umbilicus.…”

Section: Discussionmentioning

confidence: 99%

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A Triple Obstetric Challenge of Thoracopagus-Type Conjoined Twins, Eclampsia, and Obstructed Labor: A Case Report from Sub-Saharan Africa

Leigh

John-Cole

Kamara

et al. 2017

Case Reports in Obstetrics and Gynecology

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Conjoined twins are very rarely seen. We present a case of thoracopagus that was undiagnosed prior to delivery and combined with eclampsia and obstructed labor in a low-resource setting in sub-Saharan Africa. A 27-year-old pregnant woman was presented to the maternity emergency unit of Princess Christian Maternity Hospital (PCMH) in Freetown at term in labor. Upon admission, the patient was awake and orientated and presented a blood pressure of 180/120 mmHg and a protein value of 3+ on urine dipstick test. Clinical examination—ultrasound was not available—led to the admission diagnosis: obstructed labor with intrauterine fetal death and preeclampsia. Application of Hydralazine 5 mg (i.v.) under close blood pressure monitoring was performed. Under spontaneous progression of labor, one head of the yet unknown conjoined twin was born. The patient developed eclamptic fits. Ceasing of seizures was achieved after implementing the loading dose of the MgSO4 protocol. A vaginal examination led to the unexpected diagnosis of conjoined twins. An emergency cesarean section under general anesthesia via a longitudinal midline incision was performed immediately. The born head was repositioned vaginally. The stillborn conjoined twins presented a female thoracopagus type that seemed to involve the heart. After 8 weeks, the woman was clinically fully recovered.

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Section: Discussionmentioning

confidence: 99%

“…The estimated overall incidence ranges from 1 in 50,000 to 1 in 250,000 live births [ 1 – 3 ]. However, about 40–60% of the cases are stillborn [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Triple Obstetric Challenge of Thoracopagus-Type Conjoined Twins, Eclampsia, and Obstructed Labor: A Case Report from Sub-Saharan Africa

Leigh

John-Cole

Kamara

et al. 2017

Case Reports in Obstetrics and Gynecology

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“…Although both theories are postulated throughout literature, controversies remain existing (Mutchinick et al, ). Both the fission and fusion theories have crystallized in patterns of paraphrased and graphic representations in virtually every paper concerning conjoined twins (Mian et al, ). However, both theories show limitations, have overlapping dogmas and parlance—creating a potential susceptible situation for semantic interpretations.…”

Section: Introductionmentioning

confidence: 99%

Two is a Crowd

2019

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In this article, we provide a comprehensive overview of multiple facets in the puzzling genesis of symmetrical conjoined twins. The etiopathogenesis of conjoined twins remains matter for ongoing debate and is currently cited—in virtually every paper on conjoined twins—as partial fission or secondary fusion. Both theories could potentially be extrapolated from embryological adjustments exclusively seen in conjoined twins. Adoption of these, seemingly factual, theoretical proposals has (unconsciously) resulted in crystallized patterns of verbal and graphic representations concerning the enigmatic genesis of conjoined twins. Critical evaluation on their plausibility and solidity remains however largely absent. As it appears, both the fission and fusion theories cannot be applied to the full range of conjunction possibilities and thus remain matter for persistent inconclusiveness. We propose that initial duplication of axially located morphogenetic potent primordia could be the initiating factor in the genesis of ventrally, laterally, and caudally conjoined twins. The mutual position of two primordia results in neo‐axial orientation and/or interaction aplasia. Both these embryological adjustments result in conjunction patterns that may seemingly appear as being caused by fission or fusion. However, as we will substantiate, neither fission nor fusion are the cause of most conjoined twinning types; rather what is interpreted as fission or fusion is actually the result of the twinning process itself. Furthermore, we will discuss the currently held views on the origin of conjoined twins and its commonly assumed etiological correlation with monozygotic twinning. Finally, considerations are presented which indicate that the dorsal conjunction group is etiologically and pathogenetically different from other symmetric conjoined twins. This leads us to propose that dorsally united twins could actually be caused by secondary fusion of two initially separate monozygotic twins. An additional reason for the ongoing etiopathogenetic debate on the genesis of conjoined twins is because different types of conjoined twins are classically placed in one overarching receptacle, which has hindered the quest for answers. Clin. Anat. 32:722–741, 2019. © 2019 Wiley Periodicals, Inc.

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“…Survival is fraught with complications, with 35% of the live births not surviving the first 24 hours 1. Conjoined twins are classified according to the site of the union as craniopagus (head), thoracopagus (thorax), omphalopagus (abdomen), ischiopagus (pelvis), pyopagus (sacrum) and rachipagus (vertebral column) 3. These cases are associated with numerous anomalies depending on the shared organs as well as anomalies of unshared structures.…”

Section: Introductionmentioning

confidence: 99%

Conjoined twins presenting with foot deformities: insights to management and challenges

et al. 2019

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Conjoined twins are a rare outcome of conception associated with numerous anomalies involving multiple organ systems. Musculoskeletal abnormalities like vertebral anomalies, sacral agenesis, foot deformities and hip dysplasia have been described in literature. We describe two cases of pyopagus twins with congenital talipes equinovarus and congenital vertical talus deformity which have not been described previously in this type of conjoined twins. The orthopaedist should look actively for such deformities in this patient population and be wary of the difficulties associated with their management.

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Conjoined twins: From conception to separation, a review

Cited by 64 publications

References 46 publications

A Triple Obstetric Challenge of Thoracopagus-Type Conjoined Twins, Eclampsia, and Obstructed Labor: A Case Report from Sub-Saharan Africa

A Triple Obstetric Challenge of Thoracopagus-Type Conjoined Twins, Eclampsia, and Obstructed Labor: A Case Report from Sub-Saharan Africa

Two is a Crowd

Conjoined twins presenting with foot deformities: insights to management and challenges

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