The missed early diagnosis of ‘Siamese twins’ - ethical dilemma and role of family physicians
Introduction: Conjoined twins (CT) are a rare embryological developmental accident of uncertain aetiology. Despite the prevalence being uncommon, this phenomenon carries a high rate of stillbirth and early neonatal death. Early detection is crucial to avoid unnecessary surgical delivery and s...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Academy of Family Physicians of Malaysia and Family Medicine Specialist Association of Malaysia
2023
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/109165/7/109165_The%20missed%20early%20diagnosis%20of%20%E2%80%98Siamese%20Twins%E2%80%99.pdf http://irep.iium.edu.my/109165/ https://e-mfp.org/ |
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| Institution: | Universiti Islam Antarabangsa Malaysia |
| Language: | English |
| Summary: | Introduction: Conjoined twins (CT) are a rare embryological
developmental accident of uncertain aetiology. Despite the
prevalence being uncommon, this phenomenon carries a high rate of stillbirth and early neonatal death. Early detection is crucial to avoid unnecessary surgical delivery and
sychological anguish to the expecting parents. Case presentation: A 25-year-old primigravida with no known medical illness was diagnosed with conjoined twins in the second trimester. She had her early trimester scan done previously in a health clinic which showed a singleton fetus.
An ethical dilemma arises in terms of the termination of
pregnancy or continuation of pregnancy due to cultural beliefs. Subsequently, the parents agree to terminate the pregnancy. A stillborn female thoracophagus conjoined twins were delivered through spontaneous vaginal delivery weighing 750g at 21 weeks period of gestation. Lactation was suppressed and psychological support was given throughout the postnatal care.Discussion: CT is a rare phenomenon that carries high mortality and morbidity. �is condition can be recognized early with �rst-trimester ultrasound focusing on the presence of a separating membrane of twin pregnancies (Morin&Lim,2011). �e decision on termination of pregnancy is often made if the twins share vital organs (Dorairajan G, 2012). Besides, late detection as in this case had stirred psychological distress in the parents. Psychological and lactation support is important after infant death (Carroll K et al 2020). Conclusion: �e primary care physician’s role in timely prenatal diagnosis, counseling, organization of
interdisciplinary shared care, and aftercare is imperative in cases of conjoined twins and the a�ected parents. |
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