Thoracopagus conjoint twins presenting as shoulder dystocia: a case report

A thirty-eight year old, gravida seven, para six mother presented to the outpatient department of Saint Paul's General Specialized hospital on September 11, 2003 after attempted delivery of the shoulder failed at Meta Robi health center. Referral note indicated that she presented at the health center in the second stage of labor, which was delayed for more than two hours. Ventouse delivery was effected at the health center following which the shoulder could not be delivered and mother was referred to Addis for further management of the shoulder dystocia. Upon presentation to the hospital further delivery of the fetus was difficult and an ultrasound exam showed a twin pregnancy. A caesarean delivery was effected with the possibility of conjoined twinning. Stillborn 5100 grams thoracopagus twins were delivered with intraoperative decapitation of the head of the vaginally delivered twin. Mother was discharged after seven days in good condition. Literature on the diagnosis and management of conjoint twinning is reviewed and the rare situation in which a conjoined twin might be a differential diagnosis of shoulder dystocia is noted.