|Table 1: showing the severity of the join|
|Structures shared||Separate structures|
|Inferior portion of the face||Lower limbs|
|Anterior chest wall||Upper Limbs|
|Medial portion of the neck||Spine|
The patient was councilled as to the severity of the condition and the possible complications of the pregnancy and she opted for a fetocide.
The fetocide was booked 29 June.
On arrival for the procedure on the 29th the patient was found to be in the early stages of labour, during the procedure the labour progressed and Ipradol was administered intravenously and an Indomethacin suppository was given to tocolyse labour.
Once the mother had been settled the fetocide was completed by injecting 10mls of potassium chloride 15% into the shared heart of the fetuses. Once fetal death had been confirmed she was taken to theatre and a caesarean section was done to remove the fetuses as the severity of the join would have prevented normal vaginal delivery.
The caesarean section was done under general anaesthetic to prevent the mother from being further traumatised.
Once delivered the severity of the join could be assessed more closely.
The mother was given postoperative care and admitted to the ward for further management and observations.
PROGNOSIS If the conjoined twins had not been diagnosed prior to delivery she would have been in labour for a long time and eventually an emergency caesarean section would have been performed.
These babies would have been difficult for the mother to manage and the quality of life for the mother and babies would have been very poor.
The likely hood that the babies would have survived was very poor and if they did their life expectancy would have been a few months at the most. In days gone by the mother would have died in labour and the reasons for this would have gone with her to the grave.