Assisted breech vaginal delivery of dicephalus dipus dibrachius conjoined twins: a case report

Conjoined twinning is a rare congenital anomaly. Even after significant advancement in the health care delivery system in developing countries, adequate antenatal care of pregnant patients and antenatal diagnosis of congenital malformations by radiological techniques like sonogram need to be emphasized.

A 25-year-old woman (G1P0) at 38 weeks' gestation vaginally delivered stillborn dicephalus male twins with 2 heads, 2 necks, and a common trunk with 2 arms and 2 legs at Kasturba Hospital. The fetuses were in breech presentation and were delivered using assisted breech vaginal delivery. The conjoint nature of the fetuses remained undiagnosed antenatally and was clinically unsuspected during the intrapartum period. It was only confirmed after delivery. The intrapartum and postpartum course was uncomplicated, and the patient was discharged home on postpartum day 2.

The diagnosis of conjoined twins can be missed without adequate antenatal care, leading to adverse fetomaternal outcome. Antepartum diagnosis of conjoined twins with sonography with or without MRI is essential for optimal obstetric and perinatal management, preoperative surgical planning, and parental counseling. Surgical separation of conjoined twins is possible in select cases and involves a multidisciplinary approach using several specialties.