Treatment

Treatment of conjoined twins depends on their unique circumstances — their health issues, where they're joined, whether they share organs or other vital structures, and other possible complications.

Monitoring during pregnancy

If you're carrying conjoined twins, you should be closely monitored throughout your pregnancy. You'll likely be referred to a maternal and fetal medicine doctor who specializes in high-risk pregnancy. You may also be referred to other specialists such as:

• Pediatric surgeons
• Pediatric urologists
• Pediatric orthopedic surgeons
• Plastic surgeons
• Pediatric cardiologists
• Pediatric cardiovascular surgeons
• Neonatologists

Your doctors and others on your health care team learn as much as possible about your twins' anatomy, functional capabilities and prognosis to form a treatment plan for your twins.

Delivery

A C-section is planned ahead of time, often two to four weeks before your due date.

After your conjoined twins are born, they're fully evaluated. With this information, you and your health care team members can make decisions regarding their care and whether separation surgery is appropriate.

Separation surgery

Separation surgery is an elective procedure done usually a year or more after birth to allow time for planning and preparation. Sometimes an emergency separation may be needed if one of the twins dies, develops a life-threatening condition or threatens the survival of the other twin.

Many complex factors must be considered as part of the decision to pursue separation surgery. Each set of conjoined twins presents a unique set of considerations due to variations in anatomy. Issues include:

• Whether the twins share vital organs, such as the heart
• Whether the twins are healthy enough to withstand separation surgery
• Odds of successful separation
• Type and extent of reconstructive surgery needed for each twin after separation
• Type and extent of functional support needed after separation
• What challenges the twins face if left conjoined

Recent advances in prenatal imaging, critical care and anesthetic care have improved outcomes in separation surgery. After separation surgery, pediatric rehabilitation services are crucial to assist with appropriate skill development through physical, occupational and speech therapies.

If surgery isn't an option

If separation surgery isn't possible or if you decide not to pursue the surgery, your team can help you meet the medical care needs of your twins.

If the circumstances are grave, medical comfort care — such as nutrition, fluids, human touch and pain relief — is provided.