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Conjoined Twins

Conjoined Twins. Ms. Susan Chabot Health Sciences. Statistics. Approximately 40-60% arrive stillborn About 35% only survive one day Overall survival rate is between 5 and 25%. Types of Conjoined Twins. The classification of conjoined twins is determined by how the twins are joined.

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Conjoined Twins

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  1. Conjoined Twins Ms. Susan Chabot Health Sciences

  2. Statistics • Approximately 40-60% arrive stillborn • About 35% only survive one day • Overall survival rate is between 5 and 25%

  3. Types of Conjoined Twins • The classification of conjoined twins is determined by how the twins are joined. • All the names for conjoined twins end in “-pagos” this means “fixed” in Greek.

  4. Conjunctions Not Involving the Heart or Umbilicus • Craniopagus • Joined at the skull, can share portions of the brain and blood circulation. -Vertical Craniopagus -Occipital Craniopagus -Frontal Craniopagus -Parietal Craniopagus

  5. A skull of craniopagus conjoined twins • Pygopagus conjoined twins

  6. Pygopagus • Joined at the pelvis and lower spine. • Each twin has a separate heart. • Many conjoined twins that survive to adulthood have been pygopagus. • Separation is usually successful.

  7. Midline Conjunctions • Thoracopagus • Joined at the upper chest from clavicle to sternum. • Can share a heart or a pericardium. • Separation is extremely risky, both twins often die. • Parapagus • Joined side by side at the torso, usually share three legs, but have separate heads and arms.

  8. Cephalopagus • Conjoined heads and necks, sometimes they share a heart. • Omphalopagus • Joined at the abdomen, from sternum to the groin. • Often share liver, and parts of digestive system.

  9. Ischopagus: • Joined at the front pelvis and lower spine, with spines at 180-degree angles of each other. • About 70% of ischopagus twins have four legs; in the cases of three legs the third leg is shared between the twins, but not controlled by either. • Ischio-omphalopagus: • Combination of ischiopagus and omphalopagus twins. • Usually have a “Y” shape with three legs and a single set of genitalia.

  10. Ischopagus twins joined at front pelvis and lower spine • Ischio-omphalopagus conjoined twins

  11. Manar’s parasitic twin, Islaam, died after an extensive surgery. • This is a child with its sibling developing inside of it.

  12. To separate or not… • Is surgery viable? • Doctors conduct tests such as an ultrasound, MRI (magnetic resonance imaging) and 3D graphics to determine • The location and extent of the join • and whether internal organs are involved • The medical team and their experience is also a factor

  13. To separate or not… • Is surgery viable? (cont) • If surgery is safe, the effects to both twins must be taken into factor. • Are both twins equally robust? • What are the chances of one or both surviving surgery? • What quality of life is likely for one or both twins after surgery? • How does this compare with the probable quality of life if the twins remain joined?

  14. To separate or not… • Ethical Questions: • Is it right to sacrifice one twin to save the other? • Is it reasonable to invest scarce resources in uncertain operations?

  15. To separate or not… • Religious considerations • Parents knowing that one twin will die as a result of the surgery will object on religious grounds, in which case, a judge may overrule the parents decision • Parents who know that both twins have an equal chance at survival will agree to the surgery and declare that the outcome was a will of God.

  16. To separate or not… • Cultural Influences: • Where they live • Conjoined twins in Soviet Russia were treated as outcasts • If left unseparated in Africa they could be seen as outcasts and curiosities • Attitudes towards disability • Some parents can’t stand seeing disability in their children and do the surgery to avoid it even if it means they could lose one • Some parents believe that their children are better off and more able bodied when they are stuck together than when they are apart

  17. To separate or not… • What do twins think about being separated? • Some are content and have adjusted to the psychological and physiological aspects of life conjoined • A set of twins separated at age twenty-nine were very determined to be separated • Ones separated at infancy have no recollection of being conjoined, may actually be glad to have independent lives

  18. Cases of Conjoined twins • Masha and Dasha Krivoshlyapova • Born in 1950 in Moscow • Taken way from mother at birth • They had a third leg that was amputated at age 10 • They were incarcerated until age 40 in Soviet institutions that were degrading • They were tested for responses with pins and razors • They are now both alcoholics and shunned by the society they live in

  19. Cases of Conjoined twins • Lori and Reba Schappell • Born in 1961 in Pennsylvania • The only pair of unseparated twins alive today that are joined at the head • Reba is shorter and must sit on a wheeled stool • They don’t want to be separated • They were institutionalized when they were children

  20. Cases of Conjoined twins • Laleh and Laden Bijani • Born January 17, 1974 in Firouzabad, Iran • Joined at the head • Separated in July 2003 • They had a 50:50 chance of survival • Laden died an hour after separation • Laleh died 90 minutes after Laden

  21. Cases of Conjoined twins • Abigail and Brittany Hensel • Born in 1990 in the Midwest of the United States • Parents are opposed to separation because it would cause severe disabilities and the girls would have to give up their favorite activities

  22. Cases of Conjoined twins • Amy and Angela Lakeberg • Born in 1993 in the city of Chicago • Had a joined heart and liver • Amy died during separation • Angela died 10 months later of pneumonia • Their case raised some of the many issues involved in separation of conjoined twins

  23. Cases of Conjoined twins • Gracie ‘Jodie’ and Rosie ‘Mary’ Attard • Born in 2000 in Manchester UK • Joined at the lower abdomen and spine • If left unseparated both would have died • Parents opposed separation because of their Roman Catholic religion – court opposed • Rosie died • Gracie has made good progress and should lead a normal life

  24. Cases of Conjoined twins • Manar Maged • Born in March 2004 in Aghur, Egypt • The underdeveloped twin had a brain but no body • A 13 hour surgery was performed • The family named the twin that didn’t survive Islaam • Manar died in March 2006, of a severe brain infection 13 months following surgery

  25. Cases of Conjoined twins • Abigail and Isabelle Carlson • Separated in Summer of 2006 • From North Dakota • Separated at the Mayo Clinic in Rochester, MN • http://www.youtube.com/watch?v=r08wJnNmUz0

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