COJOINED TWINS: SAFE TERMINATION OF PREGNANCY THROUGH DILATION AND EVACUATION AT LATER GESTATION: A CASE SERIES

Abstract

Abstract

Background: Currently, there is limited evidence on termination of pregnancy for cojoined twin documented with only 33 cases reports to-date. This study aimed to  describe the clinical and procedure characteristics of second trimester dilation and evacuation(D&E) for cojoined twins at later gestation.

Methods: This retrospective case series was conducted at a tertiary-level hospital in Ethiopia from February 2023- July 2023. Women who had a cojoined twin pregnancy in later gestation (≥20 weeks) and underwent second trimester D&E were retrospectively studied through chart review. Clinical presentation, D&E procedural description, and procedure outcomes of the cases were analyzed. 

Results: Three women who had a cojoined twin in later gestation (≥20 weeks) and underwent second trimester D&E were identified. In two of the cases, a two- day cervical preparation with laminaria was used to prepare the cervix while overnight Foley catheter (1-day preparation) was used for similar purpose in the third case. A cervical dilation of 3 cm was achieved in all cases and was deemed adequate to proceed with the procedure by the managing physicians. Intra-operative ultrasound guidance was utilized in all the cases and there were no complications encountered.

Conclusion: Our case series underscores the importance of achieving adequate cervical preparation, utilization of intra-operative ultrasound guidance, and handling the procedure by the most experienced provider, in increasing the safety and effectiveness of D&E procedures for conjoined twin at later gestation.

Keywords: cojoined twin, dilation and evacuation, D&E for conjoined twin, D&E for twin