A Triple Obstetric Challenge of Thoracopagus-Type Conjoined Twins, Eclampsia, and Obstructed Labor: A Case Report from Sub-Saharan Africa

Abstract

Conjoined twins are very rarely seen. We present a case of thoracopagus that was undiagnosed prior to delivery and combined with eclampsia and obstructed labor in a low-resource setting in sub-Saharan Africa. A 27-year-old pregnant woman was presented to the maternity emergency unit of Princess Christian Maternity Hospital (PCMH) in Freetown at term in labor. Upon admission, the patient was awake and orientated and presented a blood pressure of 180/120 mmHg and a protein value of 3+ on urine dipstick test. Clinical examination—ultrasound was not available—led to the admission diagnosis: obstructed labor with intrauterine fetal death and preeclampsia. Application of Hydralazine 5 mg (i.v.) under close blood pressure monitoring was performed. Under spontaneous progression of labor, one head of the yet unknown conjoined twin was born. The patient developed eclamptic fits. Ceasing of seizures was achieved after implementing the loading dose of the MgSO4 protocol. A vaginal examination led to the unexpected diagnosis of conjoined twins. An emergency cesarean section under general anesthesia via a longitudinal midline incision was performed immediately. The born head was repositioned vaginally. The stillborn conjoined twins presented a female thoracopagus type that seemed to involve the heart. After 8 weeks, the woman was clinically fully recovered.

Delivery of Retained Second Twin in Case of Omphalopagus Conjoined Twins: Abdominovaginal Approach

“…On the other hand, if pregnancy continues by parents' choice or detected at advanced gestational age caesarean section it can be carried out with generous abdominal and uterine incision. On the other hand, in a situation where these cases are diagnosed intrapartum after they have developed labor abnormalities, it is unlikely that conjoined twin is considered as a cause and leads to labor ward tragedy and panic [4–8]. In the present case report, an undiagnosed case of a conjoined twin was presented in labor followed by delivery of one baby with the retention of the second baby.…”

“…Although a lot has been said in this regard, a significant number of cases go undiagnosed until after birth, and obstetrical complications which can mainly be attributed to failure to timely diagnose have been reported in case reports. In resource-limited setting like Ethiopia, it is not unusual to see that obstetrical complications are detected for the first time after they developed a far serious stage and our case is not different [4–8].…”

“…Mariatu B. et al from Sierra Leone reported a neglected case of conjoined twins presented with obstructed labor after delivery of one head where delivery is finally achieved by caesarean section after repositioning of the born head [4]. However, in their case, only the head of the first baby is delivered.…”

The Multidisciplinary Perioperative Management of Conjoined Twin Separation Surgery During the Pandemic

“…This policy was taken to ensure the safety of both mother and child since labor of the conjoined twins may be complicated by life-threatening issues, such as hanging breech labor, uterine rupture, obstructed labor, or arrest of descent. [8][9][10][11] During labor, a perinatologist with conjoined twin specialization was present to provide rapid stabilization to the twins. An intensive neonatal unit with respiratory support and round-the-clock care was prepared for the twins.…”