Successful Induction of Labor of Late–Second-Trimester Conjoined Twins

Obstetrics and Gynecology (Impact Factor: 5.18). 01/2014; 123(2). DOI: 10.1097/AOG.0000000000000038
Source: PubMed


To demonstrate that vaginal delivery is a safe alternative to hysterotomy when planning pregnancy termination of late-second-trimester conjoined twins. We present two cases of conjoined twins in the late second trimester desiring pregnancy termination.
The first case involved a multiparous 29-year-old woman at 23 6/7 weeks of gestation with thoraco-omphalopagus conjoined twins. The second case involved an 18-year-old primigravid woman at 25 1/7 weeks of gestation with pyopagus conjoined twins. Both desired pregnancy termination and to avoid hysterotomy. Inductions were initiated with Laminaria and augmented with vaginal misoprostol or oxytocin. Both patients had uncomplicated vaginal deliveries of intact conjoined twins without significant maternity morbidity.
Induction of labor and vaginal delivery can be a safe method for late-second-trimester termination of pregnancies with conjoined twins.

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    ABSTRACT: Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis is generally poor. Accurate prenatal diagnosis by an experienced multidisciplinary team using a combination of imaging modalities allows parents to make fully informed choices. This may include termination of pregnancy, which is easier and safer at the earlier gestations at which diagnosis is now being made; continuing with the pregnancy but accepting that only palliative care is appropriate after birth; or planned intensive care and separation of the twins after birth. Delivery will invariably be by cesarean section in order to minimize the risk of peripartum harm to both mother and babies.
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