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Only time will decide the chances of survival for the conjoined twins born on April 21 at De Soysa Hospital for Women
Rare happening
By Vidushi Seneviratne
The birth of a baby is an occasion of great happiness for parents. But sometimes nature has its own unique way of transforming this joyous event into a complicated and virtually life-threatening experience.

On the afternoon of April 21, Sri Lanka saw the rare birth of conjoined twins, an occurrence said to take place once in every hundred thousand births. Considered an extremely uncommon medical phenomenon, it is one that needs extreme long term care and attention, depending on the extent of complications in the condition of the babies.

Born to Priyadharshini Deepa and Tharaka Sandeeva, a young couple from Mabima, the fact that the twin girls were conjoined, was unexpected. "I got to know that I was expecting twins only in the last month, but the scan didn't show that they were joined," said the 27 year-old mother. This was her first delivery. Her husband works as a cook in a hotel.

"The babies were transferred to the other hospital after some time and I too will be sent there today," she said, when we met her last Tuesday. The delivery was by Caesarean section and took place at Ward 16 of the De Soysa Hospital for Women, under the supervision of Dr. Sri Skanthan, Consultant gynaecologist and obstetrician. The babies jointly weighing approximately 7.5 lbs were later transferred to the Lady Ridgeway Hospital's intensive care unit.

"We knew that the mother was expecting twins, but though we didn't know for certain that they were conjoined, I suspected it during the first moments of delivery," said Dr. Indika Liyanage, Senior Registrar at De Soysa Hospital who handled the birth after the 35-week pregnancy. "Though I have witnessed another birth of conjoined twins at the Castle Street Hospital for Women during my internship, those babies didn't survive. This type of delivery has to be done with the utmost care, but the delivery itself doesn't take longer than an average delivery."

Director of the Lady Ridgeway Hospital Dr. Wimal Jayantha confirmed that the twins are connected from the chest and abdomen, down to the lower pelvic area. "Though the babies are stable for now, we have to keep watching their condition," Dr. Jayantha said. "They were running a fever at one time and it may be due to an infection, which is an extremely probable situation, considering the circumstances. A meeting was held in order to discuss this case, and we will keep continuing the various essential tests to evaluate the situation," the Director added.

According to the surgeon in charge of the case at present, the separation of the twins will not take place anytime soon. "This is a very rare problem in children and it is extremely tragic for the parents, especially because of the uncertainties involved. The babies are stable at the moment, but the situation could change at any moment. We will keep assessing their condition and carrying out the required tests," he said, adding that a C.T scan due to be done soon would give further information regarding the parts of anatomy that the twins shared.

"As for the organs that are joined, so far we are certain of the liver and heart. We will be having continuous discussions about the medical requirements of the twins and we might need attention from cardio-thoracic experts as well, but nothing is certain. If the need arises, with the assistance of experts at the Sri Jayawardenapura Hospital, we should be able to handle the separation of the twins, even if they are joined by a vital organ such as the heart. But the most important factor is to what an extent they are joined. This is what we will keep assessing," he said.

Asked for a possible time-frame, he said any separation would be considered only after the twins are about six or nine months. "Right now what's most important is nursing and basically taking care of the immediate problems. A meeting will be held where all the experts concerned discuss the condition of the twins, and since we have the expertise to handle such a situation, there really isn't anything to worry about immediately. The parents have given their consent to any required surgery, but only time will tell what would be needed," he added.

After-care is vital in cases like this and protecting the babies from germs and infections is the top priority of the hospital. The emotional aspect of the situation too, is as important. "The parents are under a lot of stress. It's not like having twins or triplets, this is a totally different circumstance. Added to the fact that the condition of their babies can fluctuate at any given moment, they are constantly being questioned and put under scrutiny, regardless of what they are feeling. For everyone else, this is just another incident that would arouse curiosity, but for the parents, it's huge burden. This is why we will be keeping the babies under our care for as long as we can," said the surgeon handling the case.

Sri Lanka has experienced the birth of conjoined twins on three or four occasions in the last ten years, according to doctors but unfortunately the outcome has not been favourable. Notwithstanding all the risks involved, with the expert care and attention their babies are receiving, Priyadharshini and Tharaka might be the lucky parents of twin daughters. But it's still too early to know for sure…..only time will tell.

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