Is a classical incision the only way to perform a near-term conjoined twins’ cesarean section? Thoracopagus conjoined twin delivery by a low-segment transverse incision

Abstract

Conjoined twin pregnancies are rare, usually occurring in cases of monochorionic monoamniotic twins. The most common type of conjoined twins (42%), thoracopagus, is difficult to deliver via a low-segment transverse incision hysterotomy after 35 weeks of gestation. As a result, conjoined twin cesarean sections are typically performed using the classical incision method. However, this often leads to an increased risk of postoperative maternal morbidity and uterine rupture during a subsequent pregnancy. Due to the low survival rate of conjoined twins, subsequent pregnancies are often desired. Hence, minimizing trauma to the uterus is a primary concern. A technique for delivering conjoined twins at 35 weeks of gestation by cesarean section with a low-segment transverse incision hysterotomy is proposed here. A video is included to explain and demonstrate these procedures. This method can minimize uterine trauma and maximize the chances of a successful subsequent pregnancy.