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Conjoined twins: an obstetrician’s guide to prenatal care and delivery management

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Abstract

Objective

Obstetricians infrequently encounter conjoined twins. Much of the clinical care literature focuses on postnatal management from a neonatology and pediatric surgery perspective; guidance on obstetrical management is limited. We outline steps for prenatal evaluation, obstetrical care, and delivery planning.

Study design

Experiences with two cases of conjoined twins.

Results

We identified several points throughout the planning, delivery, and postnatal process that are important to highlight for optimizing clinical outcome, patient safety, and parental satisfaction.

Conclusion

After diagnosis, patients should be referred to a center experienced in the management of conjoined twins. Specialists in fields including maternal fetal medicine, pediatric surgery, neonatology, and radiology play a vital role in the management of these patients. Early referral allows for timely family counseling and decision-making. Prenatal evaluation beyond the first trimester should include a detailed ultrasound, fetal echocardiogram, and fetal MRI. 3D printed life-sized models can improve delivery planning and patient understanding.

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Fig. 1: Fetal MRI, case 1.
Fig. 2: Fetal MRI, Case 2.

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Data availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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Author information

Author notes

  1. D’Angela Pitts

    Present address: Henry Ford Health System, Detroit, MI, USA

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA

    Patricia S. Greco, D’Angela Pitts, Marjorie C. Treadwell & Alissa Carver

  2. Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA

    William J. Weadock, Maria Ladino-Torres & Naomi T. Laventhal

  3. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    William J. Weadock & Maria Ladino-Torres

  4. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Naomi T. Laventhal & George Mychaliska

Authors
  1. Patricia S. Greco
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  4. Maria Ladino-Torres
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  7. Marjorie C. Treadwell
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  8. Alissa Carver
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Contributions

PG formulated the concept of the paper, wrote the entire manuscript, researched prior publications, and corresponded with the co-authors on their input. DP provided input on the manuscript. WW and ML created the images and models used in the described cases and provided input on the manuscript. NL provided input on the manuscript. GM provided input on the manuscript. AC helped with formulation of the concept behind the paper, researched prior publications and provided input on the manuscript. MT helped with formulation of the concept behind the paper, researched prior publications and provided input on the manuscript. All authors approved the final submitted version of the manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Patricia S. Greco.

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Conflict of interest

The authors declare no competing interests.

Ethics approval and consent to participate

This study was performed in accordance with the Declaration of Helsinki. Both patients signed consent to participate in this review.

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Greco, P.S., Pitts, D., Weadock, W.J. et al. Conjoined twins: an obstetrician’s guide to prenatal care and delivery management. J Perinatol 41, 2424–2431 (2021). https://doi.org/10.1038/s41372-021-01107-5

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  • DOI: https://doi.org/10.1038/s41372-021-01107-5

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