I am 12 weeks pregnant with twins and have had four ultrasounds. They have all confirmed that the twins are monoamniotic. Until the fourth ultrasound by a MFM doctor no one was suspecting they were conjoined. The MFM is concerned over "a small area of the abdomen". The twins have never been clearly about from each other on ultrasound but the first three professionals to ultrasound me say that they have seen all independent fetal parts. Is it possible to have conjoined twins that are barely connected?
The most common form of conjoined twins is called Thoracoomphalopagus (75% of cases) and refers to twins that are attached at the front of their chests and upper part of their abdomen to the level of where the umbilical cord inserts. They most often share a head normal common heart (75% of cases) that has multiple structural abnormalities of the pumping chambers as well as the large blood vessels that enter and leave this structure that make surgical separation of the twins after birth impossible. Omphalopagus twins are those that are connected only at the upper abdomen, between the lower tip of the breast bone (xyphoid) and where the umbilical cord inserts into the abdomen. The abdominal cavity of one twin communicates with that of the other twin and usually contains a bridge of tissue that connects the liver of each twin. Other organs can be involved as well, and therefore careful, detailed evaluation of all the abdominal organs, as well as other organ systems such as the heart and brain need to be looked at carefully to determine whether the babies can be surgically separated after birth, or if there are other birth defects present that would worsen the chances of survival. We generally use a combination of fetal echocardiography (to look at the heart and major blood vessels) and ultra-fast fetal MRI and high resolution ultrasound to look at all the other organ systems at 18-20 weeks of pregnancy to determine whether successful surgical separation might be possible. Based on this evaluation, some families may choose to terminate the pregnancy, while others may choose to continue. For those that continue, they should have high risk prenatal care with ultrasound evaluations every few weeks to monitor growth, development issues and amniotic fluid volumes. Delivery is generally performed at 36-37 weeks of pregnancy by cesarean section to lessen the surgical risks to the mother, and often requires a vertical incision in the uterus that increases the risks for complications in future pregnancies. Because of the complexity of managing such babies after they are born, a coordinated delivery should occur at a center with a neonatal intensive care nursery and the presence of the necessary pediatric medical and surgical specialties to help care for these newborns.
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