The phenomenon of conjoined twins has long fascinated and puzzled medical experts and the general public alike. Occurring in about 1 in 200,000 live births, conjoined twins are an extremely rare phenomenon and pose a distinctive set of both medical and emotional challenges. Finding out what causes conjoined twins, recognising the early warning signs, and determining the chances for separation are key to facilitating the health and well-being of both babies and their families.
Conjoined twins are identical twins whose bodies physically join at birth. This is caused by the incomplete separation of a single fertilised egg, which happens between 13 and 15 days after conception. In conjoined twins, the embryo does not fully separate, and therefore, the twins end up joined at some regions of their bodies.
Despite being genetically identical with the same DNA and sex, their relationship may vary immensely in structure and function. This uniqueness turns diagnosis, treatment and management into an extremely individualised affair.
When describing what is responsible for causing conjoined twins, it is worth mentioning that this condition happens as a result of errors occurring during early embryonic development. In regular identical twin pregnancies, the fertilised egg splits to form two individual embryos. However, in conjoined twins, splitting is incomplete or postponed, and the developing embryos are physically fused.
The precise aetiology of this abnormal splitting is unidentified. It has no relationship to genetic inheritance or environmental influences in most instances. Instead, it seems to be a transient development anomaly. Research continues into the individual biological stimuli for this uncommon state, but no known certain preventive factors exist at this time.
The conjoined twins are classified depending on the location of the union and which organs or body structures they have in common. Among all the various types of conjoined twins, some occur more than others. Some of these are:
● Thoracopagus: Chest conjoined twins. This happens most frequently and is usually a common heart, making separation most complicated.
● Omphalopagus: Twins joined at the abdomen, perhaps with sharing of the liver, intestines, or other organs.
● Craniopagus: Joined at the head. This is a very rare form that may have shared brain tissue and is extremely neurologically challenging.
● Pygopagus: Twins joined at the buttocks, with possible sharing of the spinal cord and lower gastrointestinal system.
● Ischiopagus: Twins joined at the pelvis with common lower organs and possibly legs.
● Parapagus: Side-by-side twins who can have the possibility of fusion from the chest to the pelvis.
Every category has special medical challenges. There can be identical large organs, and they can just be connected by skin and soft tissues, which affects the chances of separation through surgery.
The conjoined twins’ symptoms are normally diagnosed during a routine prenatal ultrasound scan. Although early indications are not always obvious to the pregnant person, advanced ultrasound equipment done in the second trimester can suggest that there are two fetuses that don't move individually and are constantly in close contact.
Some of the other indications that can imply conjoined twins are:
● Limited mobility of each twin was identified on ultrasound scans
● More complex or unusual foetal heart sounds
● Excess amniotic fluid within the uterus
● Difficulty in distinguishing two separate fetal heads or bodies
In some cases, magnetic resonance imaging (MRI) or echocardiography may be utilised to make the diagnosis and identify the organs or limbs that are shared.
Whether conjoined twins can be separated depends largely on several factors, including the nature and extent of their attachment, the organs involved, and the overall health of the twins. In some cases, separation is considered quite straightforward, especially when twins are attached only by skin or soft tissue and have separate vital organs.
However, in advanced cases where the twins share one heart, one brain or critical blood vessels, surgery poses significant risks of life-threatening complications. The decision of separation follows careful assessment by multidisciplinary medical experts, and in most instances, following delivery, to assess each twin's status.
As the years have passed, imaging technology, surgical planning, and critical care advances have helped improve success rates in separation surgeries. But it is still a delicate operation and is done very carefully so as not to jeopardise one or both twins.
At Cloudnine, a premier maternity care facility, complete prenatal care includes sophisticated screening and counselling for complex conditions such as conjoined twins. With the support of specialist consultants, diagnostic machines and customised care, Cloudnine provides high-risk pregnancy care and post-delivery care. The objective is to attain the best quality of life possible for the babies and family by providing conscious and compassionate care.
Conjoined twin birth typically entails careful planning between neonatologists, obstetricians, and paediatric surgeons. It is normally planned by caesarean section in a high-risk delivery-capable centre. Postnatal examination initially focuses on the twins' physiology, e.g., shared systems and individual viability.
Ongoing medical management after delivery may include respiratory therapy, nutritional therapy, and sequential evaluations for potential separation. Certain twins, despite the inability to separate, can continue to have productive lives with physical therapy and supportive care managed based on their individualised necessities.
Learning why conjoined twins occur, what types of conjoined twins there are, symptoms and whether or not conjoined twins can be separated is important for doctors and families. With early treatment and full medical care, much of the adversity surrounding this uncommon condition can be overcome.
Cloudnine offers specialist consultations and complete care for pregnant women with unusual and high-risk pregnancies. For proper diagnosis and nurturing care, book a consultation today and let Cloudnine assist you with the utmost expertise and care.
