Conjoined twins :Causes-Symptoms-Diagnosis-Treatment
What are conjoined twins?
Conjoined twins area unit twins that area unit born with their bodies physically connected. joint twins occur once in each fifty,000 to 60,000 births. about seventy p.c of joint twins are unit feminine, and most area units stillborn. About seventy five p.c of joint twins area unit joined a minimum of partly within the chest and shared organs with each other. If they need separate sets of organs, possibilities for surgery and survival are larger than if they share constant organs. As a rule, shared heart joint twins can't be separated.
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Doctors at Children's Hospital of the city have separated twenty eight sets of joint twins and have managed the care of the many others whose separation wasn't surgically attainable.
In rare cases, twins develop so closely that their body elements are joined together. joint twins will be connected through a range of body elements, as well as the pinnacle, chest, abdomen, pelvis and buttocks. Twins joined at the chest or abdomen area unit the foremost common style of joint twins, comprising seventy fifth of all cases.
Medical terms
Conjoined twins at 2 babies World Health Organization are born physically connected to every alternative.
Conjoined twins develop once AN early embryo solely part separates to make 2 people.
Although 2 fetuses can develop from this embryo, they'll stay physically connected — most frequently at the chest, abdomen or pelvis. joint twins can also share one or additional internal organs.
Though several joint twins don't seem to be alive once born (stillborn) or die shortly after birth, advances in surgery and technology have improved survival rates. Some living joint twins may be surgically separated. The success of surgery depends on wherever the twins are joined and the way several organs are shared, likewise because of the expertise and ability of the surgical team.
separated in 11-hour operation Identical twins Nima and Dawa were separated in an 11-hour operation at Great Ormond Street Hospital where they had been since their birth The twins' parents had to make the decision because of fears that Nima may not survive if nothing was done The tiny pair shared a liver but also had separate hearts and guts and doctors wanted to avoid giving either one too much medication for fear it would damage the other twin...Read more on BBC NEWS | Health.
: What is it like to be a conjoined twin? Conjoined twins are born when an embryo begins to separate into identical twins but doesn't finish the process The result is two babies who share one body and one set of internal organs These rare twins have captured the public's attention for decades due to their rarity and unusual appearance Because conjoined twins share numerous vital organs they face health issues that can differ from those of other children Read on to learn more about what it's like to be a conjoined twin survivor.
Types of conjoined twins
The most common sites for twins to be joined are:
Thoracopagus - Joined at the chest and facing each other
Omphalopagus - Joined at the abdomen and facing each other
Pygopagus - Joined at the buttocks and perineum, and facing away from each other
Ischiopagus - Joined with a single bony pelvis and four normal lower extremities
Craniopagus - Joined at the skull with or without brain connection
Symptoms Conjoined twins
There aren't any specific signs or symptoms that indicate an identical twin physiological condition. Unlike different twin pregnancies, the womb could grow quicker than with one fetus, and there could also be a lot of fatigue, nausea and ejection early within the physiological condition. joint twins will be diagnosed early within the physiological condition mistreatment normal ultrasound.
How twins are joined
Conjoined twins square measure generally classified in line with wherever they are joined, sometimes at matching sites, and generally at over one web site. They often share organs or different components of their bodies. The precise anatomy of every try of conjoined twins is exclusive.
Conjoined twins is also joined at any of those sites:
Chest. Thoracopagus (thor-uh-KOP-uh-gus) twins are joined face to face at the chest. They typically have a shared heart and will additionally share one liver and higher viscus. This can be one in all the foremost common sites of joint twins.
Abdomen. Omphalopagus (om-fuh-LOP-uh-gus) twin area unit joined close to the point. Several omphalopagus twins share the liver, and a few share the lower part of the little viscus (ileum) and colon. they typically don't share a heart.
Base of spine. Pygopagus (pie-GOP-uh-gus) twins are commonly joined back to back at the base of the spine and the buttocks. Some pygopagus twins share the lower gastrointestinal tract, and a few share the genital and urinary organs.
Length of spine. Rachipagus (ray-KIP-uh-gus), also called rachipagus (ray-kee-OP-uh-gus), twins are joined back to back along the length of the spine. This type is very rare.
Pelvis. Ischiopagus (is-kee-OP-uh-gus) twins are an area unit joined at the pelvis, either face to face or finish to finish. Several ischiopagus twins share the lower epithelial duct, moreover because the liver and sex organs and tract organs. every twin might have 2 legs or, less ordinarily, the twins share 2 or 3 legs.
Trunk. Parapagus (pa-RAP-uh-gus) twins are joined side to side at the pelvis and part or all of the abdomen and chest, but with separate heads. The twins can have two, three or four arms and two or three legs.
Head. Craniopagus (kray-nee-OP-uh-gus) twins are joined at the back, top or side of the head, but not the face. Craniopagus twins share a portion of the skull. But their brains are usually separate, though they may share some brain tissue.
- Head and chest. Cephalopagus (sef-uh-LOP-uh-gus) twins are joined at the face and higher body. The faces are on opposite sides of one shared head, and that they share a brain. These twins seldom survive.In rare cases, twins are also conjoined with one twin smaller and fewer totally shaped than the opposite (asymmetric conjoined twins). In extraordinarily rare cases, one twin is also found part developed inside the opposite twin (fetus in fetu).
Causes Conjoined twins
Identical twins (monozygotic twins) occur once one conceptus splits and develops into 2 people. Eight to twelve days after conception, the embryonic layers which will split to make monozygotic twins begin to change into specific organs and structures.
It's believed that once the embryo splits later than this — typically between thirteen and fifteen days after conception — separation stops before the method is complete, and also the ensuing twins are conjoined.
An alternative theory suggests that 2 separate embryos could somehow fuse along in early development.
What would possibly cause either state of affairs to occur is unknown.
What is the survival rate for conjoined twins?
The survival rate for conjoined twins depends on the type of conjoined twins they are according to Mayo Clinic If the twins share only a blood supply organs that can be separated medically are typically able to survive on their own after surgery Other types of conjoined twinning require surgery before they develop organ systems and cannot survive without another organ system functioning on its own Conjoined twins who do not have one organ system shared between them have a survival rate of less than 30 percent.
Can you take apart conjoined twins?
Yes you can! It is a very delicate procedure but doctors have successfully separated conjoined twins. The two main types of conjoined twins are "parasitic" and "symbiotic." In parasitic twinning one twin (the parasite) lives off the other Symbiotic twins share anatomically correct organs and often blood vessels Surgery to separate these twins can be risky because vital organs (usually the heart or lungs) may get damaged during surgery.
Can conjoined twins survive?
Conjoined twins occur when a fertilized egg begins to split after conception and only partially separates. The result is one child with two heads and two bodies or occasionally more complex combinations (i.e. more body parts joined together - three arms, two legs etc.) Conjoined twins have been documented throughout history in numerous cultures around the world.
Has there ever been conjoined triplets?
Triplets who are almost always identical are relatively rare.There have only been a handful of cases where triplets were born as conjoined twins But whether they're joined directly or via a membrane conjoined twins will not always share the same placenta and amniotic sacs This fact makes a set of conjoined triplets even more unlikely The current record was set in North Carolina back in 2009 when four conjoined girls were delivered at 24 weeks gestation still connected by their abdomen.
Are there male female conjoined twins?
Conjoined twins are more common than you might think. Research has shown there may be as many as 200 sets of conjoined twins born in the United States each year although just 100 of these sets survive infancy. That means about one in every 40,000 births will produce conjoined twins.
How do conjoined twins' brains work?
Conjoined twins are two babies who were born with their bodies joined The vast majority of conjoined twins join at the chest but in rare cases they can also be attached at the head abdomen or extremities (arms and legs) Their medical condition is known as “Siamese” or “vanishing twin syndrome.” Although conjoined twins are completely dependent on one another for their survival and share many vital organs they develop somewhat independently – each has its own nervous system However sometimes the nerves in a fused set of organs can lead to shared sensations or decision-making processes between them.
Risk factors Conjoined twins
Because conjoined twins are so rare, and the cause isn't clear, it's unknown what might make some couples more likely to have conjoined twins.
Complications Conjoined twins
Pregnancy with conjoined twins is complicated and greatly will increase the chance of significant complications. conjoint babies need surgical delivery by C-section (C-section) thanks to their anatomy.
As with twins, conjoint babies are a unit seemingly to turn untimely, and one or each might be stillborn or die shortly after birth. Severe health problems for twins will occur directly — like hassle respiration or heart issues — and later in life, like spinal curvature, spastic paralysis or learning disabilities.
Potential complications depend upon wherever the twins area unit joins, that organs or different components of the body they share, and also the experience and knowledge of the healthcare team. Once conjoined twins are expected, the family and also the health care team ought to discuss the doable complications and the way to organize them.
Diagnosis Conjoined twins
Conjoined twins square measure generally diagnosed early in physiological condition with antepartum ultrasound. The optimum analysis amount for added antepartum testing is at eighteen weeks' gestation.
A thorough antepartum analysis is especially vital for conjoined twins, because the location and extent of wherever the twins square measure joined and what organs square measure shared plays an important role in choosing whether or not the twins are going to be divisible.
Expectant mothers visiting the middle for fetal designation and Treatment at CHOP can bear a full day of advanced imaging to gather an in depth image of the shared organs and any associated anomalies. diagnostic procedure can facilitate establishing the optimum treatment and delivery arrangement, and potential for separation when birth.
Conjoined twins are often diagnosed with exploitation commonplace ultrasound as early because of the finish of the primary trimester. More-detailed ultrasounds and echocardiograms are often used regarding halfway through physiological conditions to verify the extent of the twins' affiliation and therefore the functioning of their organs.
If associate ultrasound detects conjoined twins, a resonance imaging (MRI) scan could also be done. The MRI could offer larger detail regarding wherever the conjoined twins square measure connected and that organs they share. Fetal MRI and fetal diagnostic procedure assist with coming up with for care throughout and when physiological condition.
Treatment Conjoined twins
Treatment of conjoined twins depends on their distinctive circumstances — their health problems, wherever they are joined, whether or not they share organs or alternative important structures, and alternative potential complications.
Monitoring during pregnancy
If you are carrying joint twins, you ought to be closely monitored throughout your physiological state. you will probably be brought up as a maternal and craniate drug doctor. The World Health Organization makes a speciality of speculative physiological state. you'll even be brought up different specialists such as:
Pediatric surgeons
Pediatric cardiologists
Your doctors et al. on your health care team learn the maximum amount as potential concerning your twins' anatomy, useful capabilities and prognosis to create a treatment set up for your twins.
Delivery
An obstetrical delivery is planned earlier than time, typically 2 to four weeks before your maturity.
After your joint twins are born, they are absolutely evaluated. With this data, you and your health care team members will build selections concerning their care and whether or not separation surgery is suitable.
Separation surgery
Separation surgery is an associate degree elective procedure done typically a year or a lot at once birth to permit time for designing and preparation. Typically associate degree emergency separation could also be required if one in all the twins dies, develops a dangerous condition or threatens the survival of the opposite twin.
Many complicated factors should be thought of as a part of the choice to pursue separation surgery. Every set of joint twins presents a novel set of issues thanks to variations in anatomy. problems include:
Whether the twins share vital organs, such as the heart
Whether the twins are healthy enough to withstand separation surgery
Odds of successful separation
Type and extent of reconstructive surgery needed for each twin after separation
Type and extent of functional support needed after separation
What challenges the twins face if left conjoined
Recent advances in antepartum imaging, crucial care and anesthetic care have improved outcomes in separation surgery. When separation surgery, medicine rehabilitation services are a unit crucial to help with applicable talent development through physical, activity and speech therapies.
If surgery isn't an option
If separation surgery is not attainable or if you choose to not pursue the surgery, your team will assist you meet the medical aid wants of your twins.
If the circumstances are grave, medical comfort care — like nutrition, fluids, human bite and pain relief — is provided.
Coping and support
Learning that your unborn twins have a serious medical issue or dangerous condition is often devastating. As a parent, you struggle with troublesome choices for your conjoined twins and therefore the unsure future. Outcomes are often troublesome to work out, and conjoined twins UN agency survive typically face tremendous obstacles.
Because conjoined twins are rare, it should be troublesome to seek out apparent resources. raise your health care team if medical social staff or counselors are a unit on the market to assist. betting on your desires, provoke info on organizations that support folks UN agency have youngsters with vital physical conditions or UN agency have lost youngsters.
Preparing for your appointment
If you are pregnant with joint twins, you will be named a team of specialists to assist guide you and build a treatment arrangement for your twins. Here's some info to assist you make preparations and what to expect from your doctor.
What you can do
Before your appointment:
Consider taking a family member or friend along. Sometimes it may be onerous to recollect all the data provided throughout a meeting. somebody World Health Organization comes with you'll bear in mind one thing that you simply incomprehensible or forgot.
Make a list of questions to ask your doctor. List your questions from most to least important to make the most of your appointment time.
Some basic questions to ask your doctor include:
What tests do my twins need?
Where are my twins joined and what, if any, body organs do they share?
What is the best treatment plan?
Is separation an option? What is the likely outcome with separation?
How many separation surgeries have you and your team performed, and how many have been successful? How does that compare with the national success rate?
What are the alternatives to the treatment approach that you're suggesting?
What specialists should be involved in the healthcare team?
Are there any other specialists I should meet with?
Where can I find support for my family?
Are there printed materials that I can have? What websites do you recommend?
If I choose to have more children, is there a chance they may also be conjoined?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor and health care team can review your joint twins' tests and communicate results and discuss choices with you. at the side of your health care team, you'll be able to build choices for your twins' treatment and care.
General summary
Conjoined twins occur when a fertilized egg splits unevenly creating an incomplete separation of the two cells Conjoined twins are identical and form a connecting link between their bodies If they are attached at the head or brain this type is called craniopagus If the connection is somewhere else in the body - like chest stomach or genitalia - it's somatic About 40 percent of conjoined twins are connected at just one part of the body; 60 percent share vital organs or other structures The twins may be perfectly formed but sharing parts such as tissue and bone or underdeveloped with only some shared.
