An Inseparable 28 Weeks Conjoined Twins: A Report from a Teaching Hospital in the North of Iran

Abstract

Introduction: This case report underscores the critical importance of early and accurate prenatal care in identifying serious fetal anomalies, such as conjoined twins (CT), which can significantly impact maternal and fetal outcomes. The failure to provide standard prenatal care not only led to a missed opportunity for early diagnosis but also resulted in a late-term cesarean delivery that inflicted considerable psychological trauma on the mother. Case Presentation: A 29-year-old pregnant woman with suspicion of CT was referred to Al-Zahra teaching hospital due to painful contractions. She had not received standard prenatal care, and the first assessment was performed at 28 weeks of pregnancy. The results of abdominal examinations and Leopold maneuver showed that the fundal height (the distance from pubic bone to the top of the uterus) was about 30 centimeters and the fetal heart rate was 140 beats per minute. Abdominal ultrasound showed the two fetuses were conjoined from the face to the thoracic region. Due to the non-separable case, the pregnancy was terminated by cesarean section (CS) under spinal anesthesia. The CT weighed 1120 g and measured 38 cm in height and died after a while with no resuscitation effort. Conclusions: This report emphasizes that a history of healthy pregnancies does not guarantee future uncomplicated pregnancies. Therefore, it is crucial for healthcare policymakers to implement comprehensive strategies ensuring that all pregnant women have access to necessary prenatal care, regardless of their financial situation or awareness of available services.