Undiagnosed Parapagus Dicephlus Conjoined Twins: A Case of Assisted Vaginal Breech Delivery

Abstract

Background: Parapagus (anterolaterally joined at the chest, abdomen, and pelvis) dicephalus (two-headed) twins are rare types of conjoined twins. Vaginal delivery of undiagnosed conjoined twins are a rare occurrence and associated with Dystocia, maternal and fetal trauma. We aimed to share this rare form of conjoined twin delivered vaginally and the need for obstetric ultrasound for early diagnosis and management.Case Presentation: We reported a 22 years old Gravid -2, Para-1 (alive, vaginal delivery) mother who does not recall the first day of last normal menstrual period but claimed to be amenorrheic for the last 9 months. She had no obstetric ultrasound during her follow-up. She was referred from a nearby health center to Adama Hospital Medical College with the diagnosis of breech presentation + active first stage of labor + intrauterine fetal death. Upon arrival, she was in the second stage of labor, and the fetus was delivered to the level of the umbilicus, up on pushing the whole trunk delivered to the level of the neck. With gentle down traction and suprapubic pressure, two fetal heads were delivered. A 2900-grama 2900-gram male stillborn had two heads, two necks, two upper and lower extremities, and a single trunk. The mother had no significant vaginal bleeding and no genital tract laceration. She was discharged on her 3rd postpartum day.Conclusions: All pregnant women should have at least one obstetric ultrasound during their antenatal care follow-up to make the diagnosis of conjoined twins at an earlier gestational age, which is very important to guide the subsequent management. [Ethiop. J. Health Dev. 2024; 38(3): 00-00]Keywords: Conjoined Twins, Parapagus Dicephalus, Case Report.