How do siamese twins come about?

Nov 09, 2011

On October, 28, 2001, Margret checked into a health centre in Arua district to deliver her baby, however, she was immediately referred to a hospital after developing complications.

By Agnes Kyotalengerire
 
On October, 28, 2001, Margret checked into a health centre in Arua district to deliver her baby, however, she was immediately referred to a hospital after developing complications. To her surprise, she delivered two girls by caesarean section, and they were joined at the torso. The twins, Loius and Christine, shared a liver and the main blood vessel that connects their hearts. 
 
The issue of siamese twins is not unique to Uganda. There are many cases reported worldwide.  
Siamese twins refers to babies born with their bodies joined in some way, sometimes sharing the same organs.
 
According to Dr. Charles Kiggundu, a consultant gynaecologist at Mulago Hospital, siamese twins are a result of one fertilised egg, which did not split completely to form two babies. The babies, therefore end up joined at certain parts, sharing some organs. 
 
“Separation of the fertilised egg takes about 65 days. If the egg has not separated completely by that time, the twins become conjoined,” he explains. Conjoined twins are partly responsible for miscarriages and stillbirths in twin pregnancies. Kiggundu says about 50% of conjoined twins will make it to full term and when born, about four out of 10 are stillbirths. Those born alive may have abnormalities.
 
The condition is common among girls and when born, they tend to have a higher chance of survival as opposed to the boys. 
 
Why more cases recorded
There are no predisposing factors, however, the incidence of conjoined twins rises with the increasing number of twins in a given population,” says Dr. Jolly Nankunda, a senior consultant paediatrician and neonatologist at Mulago. 
 
Different societies have contradicting theories to explain the origins of conjoined twins. In the past, some communities would neglect the twins until they died. However, today there is increased awareness and people know that something can be done to help the babies survive. Besides, improved communication makes it possible for news to spread fast.  
 
Can the condition be detected early?
“It is possible to detect it early, but only when a mother is attending antenatal care. Even with a midwife just palpitating, there is cause for suspicion when the baby is lying in an abnormal way in the womb. Sometimes the babies are transverse (lying across the abdomen).
 
Though conjoined twins may not be suspected, a midwife may refer a mother to a higher level health unit for further investigations,” Kiggundu says. 
 
Why is it common in rural areas?
Nankunda notes that the majority of mothers, especially in rural areas, do not seek antenatal care or if they do, they attend only once, which makes it difficult to detect the condition before birth. She adds, however, that not all mothers who attend antenatal can access an ultra-sound scan because the facility is not available in lower level health units and some of the smaller private units.
 
 “With better equipment, for example modern ultrasound scans, an anatomy scan can be done and one is able to look at different organs in different babies. But this also greatly depends on how skilled the medical worker is,” Kiggundu explains. 
 
“Even with the use of the ultrasound, some cases may go undetected, only to be discovered during delivery.” With such cases, presentation is bad, for example, the breech position (where the bottom or feet come out first), causes obstructed labour and delivery is only done by C-section,” he explains.
 
Early detection is important to help parents have a birth plan, which in this case is a C-section because a mother cannot manage to push babies, who are joined. Besides, there may be various cultural beliefs surrounding conjoined twins, so early detection enables the parents go through counselling to dispel rumours, misconceptions and fears in order to accept the twins. 
 
When is it safe to separate twins?
Kiggundu says before any attempt to separate the twins, a detailed investigation has to be done and the team of surgeons has to determine whether vital organs like the heart, liver and brain are shared. In addition, they have to determine the technicalities of separating what body parts the twins share, so as to determine the chances of survival. 
 
The surgeons may decide to sacrifice one baby to save the other, which the parents may not agree to. In regard the decision to separate needs to be taken when parents are firm and have consented.  
 
Success of surgery
“This is greatly determined by the babies’ weight. They must have gained a minimum weight of 10kg to be able to withstand the long hours of surgery. Most anaesthetic agents work best at 10kg and above,” says Dr. Sabrina Kitaka, a paediatrician at Mulago. 
 
The twins should be protected from getting infections because this may compromise the chances of a successful operation and recovery, Nankunda adds. Before surgery there is need to screen the babies for diseases to ensure they are in good health.
 
Separation is a task that cannot be done by only one surgeon. A team of experts needs to come together for a better operation. “The amount of preparation made before surgery determines the succ

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