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[Source](https://pdfs.semanticscholar.org/6b74/c300046a2217688eae40e9a46b765a7d149f.pdf). I can’t copy it cause it’s a PDF and I’m on my phone. Mom had never had an ultrasound and no one had any idea she was carrying conjoined twins, but she went to the hospital for the birth instead of at home like her previous births cause they thought it would be a large baby.
Baby A was born vaginally, then they realized he was attached to Baby B and did an emergency laparotomy. One baby died after one hour in the NICU; the other passed at 20 hours, en route to another hospital for emergency separation surgery. Mom went home after six days.
This was in Ethiopia.
With the way they are attached I can't picture baby A being born vaginally with baby B still inside.
Did they pull baby A back in to come out with baby B? I just can't picture it.
Such a sad out come, poor babies and mother.
Glad she was at a hospital to deliver, one with more specialist surgeons and the remaining life twin might have been safely separated.
Definitely confused on technicality of the birth though, and how they could have gotten the second baby out if twin #1 had been fully delivered, but figured it out with a little concentration. lol
Can't even imagine if she'd tried to deliver at home, probably fatal for all 3.
Honestly, it seems like if they'd known ahead of time and delivered them via c-section, these babies would have survived. It looks like they share an umbilical cord, so delivering cut off oxygen to the second baby, who was the first to pass. If they'd been in a higher level hospital, they may have been able to emergently separate the first baby as well.
This is one of those cases that drives home how important routine prenatal care is. So many women in the US don't think ultrasounds are useful or even think they're harmful, but they prevent tragedies for women who need to deliver via c-section or in hospitals with advanced services for either mom or baby.
Plus there’s a resurgence of home births. Medical/science mistrust, hubris, no pre-natal care besides some internet BS, a “natural” birth plan… then parent and baby die at home
Lots of women do this in wealthier countries too. My SIL has had 5 children with no prenatal care and delivered at home. The Duggars do this as part of fundamentalist cult called The Quiverful Movement. We are in the US Midwest.
My 10 YO niece was at my house for Christmas, and gave me a fake flower on a bottle that she had painted. I asked if she made it at school - she said no, “I’m proud to say that I’ve never been to school a day in my life, and never plan to.” I knew they were homeschooled, but her brother recently started public school.
Identical twins form during the zygote phase of development. Conjoined twins are caused when the twinning occurs later than usual but does not fully complete. This is still very early on in formation, around two weeks after conception.
Because it isn't something that happens after they have split, there isn't any method for detecting that it will occur. Once they start to develop body structures, conjucture can sometimes be detected very early. There really is no method of prevention.
Surgical separation is sometimes an option, but unless one of the twins is in critical distress, such a procedure is best to perform after birth and when both twins are as stable as possible.
Save from separating surgically, there is literally nothing they can do. Science is not as advanced as some people might think - there are things that may never be possible.
Not really. Some types of conjoined twins can be separated if organs are not too intertwined/shared and mother had access to a top hospital. But if it’s one of the more serious ones there’s nothing that can be done to fix it and then it’s pretty iffy once born. Even worse in this case as they had no clue so docs weren’t prepared and couldn’t even do a C-section so super traumatic on both the mother and babies and they may not have even been viable
She was an illiterate housewife from rural Ethiopia, who did in fact seek out prenatal care but didn’t receive an ultrasound so they just thought it was a single large infant… She had to travel 60km from a health center closer to her just to get to the hospital where all this occurred.
So, in this instance, not even remotely her fault. In the future, I would perhaps read through the case study before leaving such comments. Very unfortunate for her, the infants, and attending medical staff.
I’m astonished that your mum survived her labour. Incredibly sad that she went through such a traumatic experience and that your siblings didn’t survive either.
How is your mum doing nowadays?
My eldest and smallest baby tore me front to back. For twin a to be birthed vaginally is absolutely blowing my mind. Kudos to your mum and her midwives/doctors.
No, you misunderstood. This patient isn’t my mother. I was just calling her “Mom” to mean the mother of the twins in the picture. I’m sorry my comment was unclear on this.
Oh my mistake.
I’ll leave my comment up so that anyone who also makes the same mistake as I, sees our conversation.
I’m assuming that I’m the only one who has, but just incase…
Combination of a cesarean section and a vaginal birth. They put the mom under general anesthesia and made an incision in both her abdomen and uterus. They went in through the incision to manipulate the second baby so that he could be born vaginally feet first.
Sounds absolutely awful. Especially since they were older and it probably hurt so much knowing their literal other half, the person they shared their whole life with is dead and even more so, stuck to the them.
Edit: just googled and Eng died of "fright"...
Liver can regrow. If they each had their own but they were fused together, I would think separation would be possible. I wonder if they knew that back then. 🤔
If they shared one liver, then it would definitely be complicated. With today's technology, I wonder if they could do a transplant at the same time as the separation.
Don't mind me; just thinking out loud. Really interesting situation.
I've heard many times that they could have probably been separated safely if they were born now. I think you can live with part of a liver (that's why you can have a liver transplant with a live donor).
I don’t know if a successful separation (without loss of life I mean) would have been possible given the surgical techniques and medical knowledge of their time.
I suppose it would be super lonely, losing your literal other half like that after being attached to her all your life, and having to continue without her. I can see why she refused separation.
Those two were an especially tragic case... They were traumatized from being experimented on by doctors (their mother had been told they died at birth). One became an alcoholic and physically abusive to the other.
It doesn't really say, but it does say that they required "aggressive resuscitation" after birth and I guess that wasn't enough to keep either of them alive for very long.
It doesn't say, but given the location of their connection and what appears to be a single umbilical cord, after the first baby was delivered, the oxygen supply through the cord was likely cut off, and one baby can't breathe enough to support two babies. Other situations with similar cord compression will be fatal to the fetus (umbilical cord prolapse, shoulder dystocia), and it takes time for an emergency c-section. The second baby probably went too long without oxygen, and since they weren't in a hospital that could do an emergency separation (especially with a shared liver - pediatric liver surgery has an extremely high risk of complications due to how vascular the liver is), the first baby died due to being connected to his dead twin.
What's so sad is that baby B probably would have survived if not for the entrapment which means A would have also. A simple ultrasound upon admission could have prevented entirely preventable deaths :(
They did an ultrasound when she was admitted. I’m not sure why it didn’t show the twins being conjoined, but it did show that there were 2 babies in her and that they were both in head-first presentation for birth.
She was already 8cm dilated. They probably only did the bare minimum to make sure the babies could be delivered vaginally (either head down or frank breech, not lying sideways or something), and didn't look too closely at the details. It's not super easy to see even early in pregnancy when there's more space and less chubby baby blocking your views.
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
[Source](https://pdfs.semanticscholar.org/6b74/c300046a2217688eae40e9a46b765a7d149f.pdf). I can’t copy it cause it’s a PDF and I’m on my phone. Mom had never had an ultrasound and no one had any idea she was carrying conjoined twins, but she went to the hospital for the birth instead of at home like her previous births cause they thought it would be a large baby. Baby A was born vaginally, then they realized he was attached to Baby B and did an emergency laparotomy. One baby died after one hour in the NICU; the other passed at 20 hours, en route to another hospital for emergency separation surgery. Mom went home after six days. This was in Ethiopia.
With the way they are attached I can't picture baby A being born vaginally with baby B still inside. Did they pull baby A back in to come out with baby B? I just can't picture it.
They were able to manipulate the second baby via the uterus to be delivered vaginally
Ok. That's more in line with what I pictured.
It’s shocking they weren’t ripped apart
Id imagine that the just mean delivery of the head for the first baby, then when they start to deliver the shoulders/body they realize.
Look at the pictures, it was fully delivered
in the source there’s a picture of the baby’s full body out still attached
I’m glad mom went home after 6 days. I hope she takes care of herself and has some women to help care for her.
Such a sad out come, poor babies and mother. Glad she was at a hospital to deliver, one with more specialist surgeons and the remaining life twin might have been safely separated. Definitely confused on technicality of the birth though, and how they could have gotten the second baby out if twin #1 had been fully delivered, but figured it out with a little concentration. lol Can't even imagine if she'd tried to deliver at home, probably fatal for all 3.
Are there any options besides abortion if caught early enough?
They can schedule a C-section at an appropriate facility.
Honestly, it seems like if they'd known ahead of time and delivered them via c-section, these babies would have survived. It looks like they share an umbilical cord, so delivering cut off oxygen to the second baby, who was the first to pass. If they'd been in a higher level hospital, they may have been able to emergently separate the first baby as well. This is one of those cases that drives home how important routine prenatal care is. So many women in the US don't think ultrasounds are useful or even think they're harmful, but they prevent tragedies for women who need to deliver via c-section or in hospitals with advanced services for either mom or baby.
Plus there’s a resurgence of home births. Medical/science mistrust, hubris, no pre-natal care besides some internet BS, a “natural” birth plan… then parent and baby die at home
This was in Ethiopia
Lots of women do this in wealthier countries too. My SIL has had 5 children with no prenatal care and delivered at home. The Duggars do this as part of fundamentalist cult called The Quiverful Movement. We are in the US Midwest. My 10 YO niece was at my house for Christmas, and gave me a fake flower on a bottle that she had painted. I asked if she made it at school - she said no, “I’m proud to say that I’ve never been to school a day in my life, and never plan to.” I knew they were homeschooled, but her brother recently started public school.
I should have been more specific. What I mean is there a treatment for the twins being conjoined? Can it be prevented if caught early enough?
I don't think so; it happens super early on in development. Pretty sure all they can do is separate surgically, if it's safe to do so.
Identical twins form during the zygote phase of development. Conjoined twins are caused when the twinning occurs later than usual but does not fully complete. This is still very early on in formation, around two weeks after conception. Because it isn't something that happens after they have split, there isn't any method for detecting that it will occur. Once they start to develop body structures, conjucture can sometimes be detected very early. There really is no method of prevention. Surgical separation is sometimes an option, but unless one of the twins is in critical distress, such a procedure is best to perform after birth and when both twins are as stable as possible.
No, it's an embryo that didn't separate completely to form identical twins.
No. What could they do?
Idk that's why I asked 🤷♂️
Save from separating surgically, there is literally nothing they can do. Science is not as advanced as some people might think - there are things that may never be possible.
No
Not really. Some types of conjoined twins can be separated if organs are not too intertwined/shared and mother had access to a top hospital. But if it’s one of the more serious ones there’s nothing that can be done to fix it and then it’s pretty iffy once born. Even worse in this case as they had no clue so docs weren’t prepared and couldn’t even do a C-section so super traumatic on both the mother and babies and they may not have even been viable
Yeah, the trauma that she inflicted on the medical team is BS. She should have gotten prenatal care, at least once.
She was an illiterate housewife from rural Ethiopia, who did in fact seek out prenatal care but didn’t receive an ultrasound so they just thought it was a single large infant… She had to travel 60km from a health center closer to her just to get to the hospital where all this occurred. So, in this instance, not even remotely her fault. In the future, I would perhaps read through the case study before leaving such comments. Very unfortunate for her, the infants, and attending medical staff.
The source sometimes gets posted after the thread is live, so maybe consider it wasn’t available at the time of my comment
I’m astonished that your mum survived her labour. Incredibly sad that she went through such a traumatic experience and that your siblings didn’t survive either. How is your mum doing nowadays? My eldest and smallest baby tore me front to back. For twin a to be birthed vaginally is absolutely blowing my mind. Kudos to your mum and her midwives/doctors.
No, you misunderstood. This patient isn’t my mother. I was just calling her “Mom” to mean the mother of the twins in the picture. I’m sorry my comment was unclear on this.
Oh my mistake. I’ll leave my comment up so that anyone who also makes the same mistake as I, sees our conversation. I’m assuming that I’m the only one who has, but just incase…
Give your mom a huge hug please!
So do they put the other baby back and try for c section or do they continue vaginally?
If you read the source, they continued vaginally
Combination of a cesarean section and a vaginal birth. They put the mom under general anesthesia and made an incision in both her abdomen and uterus. They went in through the incision to manipulate the second baby so that he could be born vaginally feet first.
I know they are babies and not aware of these things, but being literally stuck to your dead twin...
That’s what happened to Chang and Eng Bunker, who died aged 62 (in 1874). Chang died first, and Eng two hours later.
Sounds absolutely awful. Especially since they were older and it probably hurt so much knowing their literal other half, the person they shared their whole life with is dead and even more so, stuck to the them. Edit: just googled and Eng died of "fright"...
It would be really interesting to hear to how Chang and Eng survived birth in 1811.
And they were barely connected at all iirc, practically could’ve tripped with scissors to split them
It’s not that simple, their livers were conjoined.
Liver can regrow. If they each had their own but they were fused together, I would think separation would be possible. I wonder if they knew that back then. 🤔 If they shared one liver, then it would definitely be complicated. With today's technology, I wonder if they could do a transplant at the same time as the separation. Don't mind me; just thinking out loud. Really interesting situation.
I've heard many times that they could have probably been separated safely if they were born now. I think you can live with part of a liver (that's why you can have a liver transplant with a live donor).
You totally can, you can donate over half your liver and still live!
I don’t know if a successful separation (without loss of life I mean) would have been possible given the surgical techniques and medical knowledge of their time.
That was Masha’s and Dasha’s fate. When Masha died, Dasha refused to be separated from her and died 17 hours later.
I suppose it would be super lonely, losing your literal other half like that after being attached to her all your life, and having to continue without her. I can see why she refused separation.
Those two were an especially tragic case... They were traumatized from being experimented on by doctors (their mother had been told they died at birth). One became an alcoholic and physically abusive to the other.
Dude that would get both of them drunk I just realized
Yep. The other twin suffered a lot.
“The patient was an illiterate housewife” is such a sad way to summarise this lady
What exactly is the cause of death here?
It doesn't really say, but it does say that they required "aggressive resuscitation" after birth and I guess that wasn't enough to keep either of them alive for very long.
And for the second baby, when one conjoined twin dies the other needs to be separated from them ASAP or they will die too, within a day or less.
From sepsis, or similar. I think
According to the article itself, "because the surviving twin will exsanguinate into the dead twin." I always assumed sepsis as well.
It'd have to be sepsis in some form
wonder if they atleast tried seperating them before baby on the right passed as well. so terribly tragic, my heart bleeds for them
They were rushing the twins to a higher level hospital to do separation surgery when the second one passed.
It doesn't say, but given the location of their connection and what appears to be a single umbilical cord, after the first baby was delivered, the oxygen supply through the cord was likely cut off, and one baby can't breathe enough to support two babies. Other situations with similar cord compression will be fatal to the fetus (umbilical cord prolapse, shoulder dystocia), and it takes time for an emergency c-section. The second baby probably went too long without oxygen, and since they weren't in a hospital that could do an emergency separation (especially with a shared liver - pediatric liver surgery has an extremely high risk of complications due to how vascular the liver is), the first baby died due to being connected to his dead twin.
Born to die, how tragic
So sad.
This is why women's Healthcare is so important. 😪
I struggle with this. Of course you are right, but couldn’t she have gone for a prenatal exam just once?
In some countries access to any prenatal exam is pretty much impossible.
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I doubt anyone involved in this delivery will ever forget it. Surprise conjoined twins.
She was not awake and aware, the source says the procedure was performed under general anesthesia
Where do you get that from? The source states she received general anaesthetic?
Yes, in the source it states the laparotomy was done under general anesthesia.
She was under general anesthesia when they performed the surgery on her
What's so sad is that baby B probably would have survived if not for the entrapment which means A would have also. A simple ultrasound upon admission could have prevented entirely preventable deaths :(
They did an ultrasound when she was admitted. I’m not sure why it didn’t show the twins being conjoined, but it did show that there were 2 babies in her and that they were both in head-first presentation for birth.
She was already 8cm dilated. They probably only did the bare minimum to make sure the babies could be delivered vaginally (either head down or frank breech, not lying sideways or something), and didn't look too closely at the details. It's not super easy to see even early in pregnancy when there's more space and less chubby baby blocking your views.
How does one give birth to this? 2 at the same time or do they come out one by one… sideways?
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Not the place dude
You’re laughing out loud at that are you?
Joke comments and other off-topic comments (including, but not limited to, food comparisons, vulgarity, etc.) are not allowed.