Management of conjoined twins

Anaesthetic management of a craniopagus conjoined twin delivery

We report the successful caesarean delivery of craniopagus conjoined twins in a 21-year-old using a neuraxial technique. Early diagnosis at 19(+5) weeks of gestation enabled thorough multidisciplinary antepartum planning. The multidisciplinary approach aimed to reduce maternal and fetal morbidity. Teams involved in the delivery included the specialities of obstetrics, neonatology, anaesthesia, paediatric neurosurgery and radiology. The delivery was complicated by an anterior placenta. The obstetricians used a J-shaped incision avoiding the placenta and making space for the fetal heads at delivery. Regional anaesthesia was used successfully in this case; although plans had been made should the mother need general anaesthesia intra-operatively. At delivery there were 17 members of the multidisciplinary team present in the operating theatre. They were from five specialities from two separate hospitals. We discuss the anaesthetic considerations for the delivery of conjoined twins and the multidisciplinary approach used in this case.

The antenatal diagnosis of cephalothoracopagus Janiceps conjoined twins

A case of cephalothoracopagus conjoined twins (Janiceps twins) is presented. The abnormality was detected antenatally by the use of ultrasonography and confirmed postnatally, clinically and by computed tomography (CT scan).