Conjoined twins are a disorder in which twins with one or more parts bodies stick together or are connected to each other. Conjoined twins are a rare condition.
In conjoined twins, the bodies of the two babies can be fused or connected to one or more body parts. The most frequently fused body parts are the head, chest, abdomen, back, and pelvis. This condition occurs due to imperfect division of the monozygotic twin pregnancy (one egg).
Conjoined twins have the potential to die while still in the womb or die shortly after birth. However, there are also those who can survive.
Symptoms of Conjoined Twins
When experiencing pregnancy with conjoined twins, there are usually no specific symptoms. Complaints that occur during pregnancy are generally the same as pregnancies with other normal fetuses, such as weakness, nausea, and vomiting in early pregnancy.
Just like a pregnancy with twins, the uterus of a pregnant woman will usually appear enlarged faster than a pregnancy with a single fetus.
Types of conjoined twins
Conjoined twins are divided into several types based on the organs or body parts that are connected to each other. Here is the explanation:
- ThoracopagusConjoined twins occur when the baby's chest is pressed against each other. The chest is the body part that is most often connected in the case of conjoined twins. Generally, they only have one heart, one liver, and one intestine.
- OmphalopagusConjoined twins occur when the stomachs of the two babies stick together. Generally, conjoined twins have only one liver, one lower small intestine, and one large intestine.
- PygopagusConjoined twins occur when the baby's lower back and buttocks are pressed together. Generally, they have only one digestive tract, one genitalia, and one urinary organ.
- CraniopagusConjoined twins occur when the baby's head is attached to the side or the top of the head. Generally they have one skull, but have different brains.
- ischiopagusConjoined twins occur when the baby's pelvis is attached to each other, either facing each other or back to back.
- ParapagusConjoined twins occur when the baby's pelvis, abdomen, and chest are attached to each other in a sideways position.
- CephalopagusConjoined twins occur when the baby's faces stick together. Generally, their faces are on opposite sides and have only one brain. Babies who experience this condition are very difficult to survive.
- RachipagusConjoined twins occur when the two babies' spines stick together. This case is very rare.
In addition to the several types of conjoined twins above, there is one other type known as parasitic conjoined twins. In this condition, the physique of one of the twins is smaller and not fully formed.
When to go to the doctor
You are advised to go to the doctor for a pregnancy test if you experience a delay in menstruation, especially when you are planning a pregnancy. Examination needs to be done to confirm the occurrence of pregnancy.
Check with the doctor regularly during pregnancy to ensure the health of the mother and fetus. The recommended routine inspection schedule is:
- Before the 28th week, once a month.
- Week 28-35, every 2 weeks.
- 36th week until birth, once a week.
Checks need to be done more often if you have certain health conditions or have experienced complications in a previous pregnancy.
If your baby is having conjoined twins, it is necessary to have regular check-ups with the doctor after delivery. Babies born with this condition have the potential to experience health problems, depending on the part of the body that is connected. A doctor's examination is carried out to prevent complications.
Causes of Conjoined Twins
Conjoined twins occur when the division of monozygotic twin fetuses (one egg) is delayed and eventually does not complete completely. This division process usually occurs 8 to 12 days after the egg meets the sperm.
If it is too late and exceeds this time period, the cleavage tends to stop before the process is complete. As a result, twins will be born attached to each other.
Another theory states that conjoined twins occur because the two eggs that were originally separated, re-attach and fuse during pregnancy. However, so far the exact causes and risk factors for these two allegations are unknown. Research is still being done to prove it.
Diagnosis of Conjoined Twins
Conjoined twins can be identified through ultrasound examination since the first trimester of pregnancy. A more detailed examination can be done in the second trimester through ultrasound and echocardiogram to see how far the twins are connected and how each organ functions.
If the results of the examination show that the baby has conjoined twins, a follow-up examination will be carried out with an MRI scan. These scans can help doctors find out in more detail the parts of the baby's body that are connected and what organs they both have.
Conjoined Twins Treatment
The treatment for conjoined twins will be determined based on the part of the baby's body that is connected, the organs they have, the health problems they experience, and the complications that may arise.
During pregnancy, mothers who carry a fetus with conjoined twins will get extra supervision from a doctor. Through this supervision, the doctor will determine the necessary treatment according to the anatomy and function of the body, as well as the level of safety of the baby.
For conjoined twins delivery, caesarean section is the best method of delivery. This operation will usually be planned in advance, which is 2-4 weeks before the expected due date.
After birth, the conjoined twins will be thoroughly examined by a doctor. From this examination, the doctor will determine the appropriate method of separation surgery. This procedure is generally done after the baby is 1 year old or older.
Separation surgery may also be performed soon after birth if the conjoined twins develop a life-threatening condition. The method of operation is determined based on the health conditions of the two babies, which can be seen from the following aspects:
- Completeness of body organs, such as the heart, liver, and intestines of each baby.
- Stability of the health conditions of the two babies.
- Estimated success rate of separation operation.
- Type and level of difficulty of reconstructive surgery after separation surgery.
- The type of care and assistance needed after separation surgery.
- Health problems that may be experienced if the separation surgery is not performed.
If the separation surgery is successful, rehabilitation and follow-up care needs to be done to train each baby's abilities. This treatment can be done through physical therapy, communication, and social. This is so that both babies can carry out normal activities like babies in general.
If separation surgery is not possible, for example because both babies only have one heart, or the baby's parents don't want their child to be operated on, the doctor will plan further medical care to ensure the health of the conjoined twins.
Complications of Conjoined Twins
Pregnancy with conjoined twins is quite complicated and can cause serious complications, both for the mother and the fetus. Conjoined twins tend to be born prematurely and have the potential to die in the womb or die shortly after delivery.
In conjoined twins who are successfully born, several complications can arise after birth, generally in the form of shortness of breath or heart problems. The risk of other complications may also arise over time, such as scoliosis and cerebral palsy.
Prevention of Conjoined Twins
Because the exact cause and risk factors are unknown, conjoined twins are difficult to prevent. The best thing that can be done is to carry out routine pregnancy check-ups to monitor the health of the mother and fetus. That way, the possibility of complications can be immediately identified, including if you are pregnant with conjoined twins.