# Parapagus dicephalus dipus tribrachius conjoined twins: a case report

## TL;DR

This paper reports a rare case of conjoined twins with a unique physical configuration and highlights the importance of early prenatal diagnosis for better outcomes.

## Contribution

The paper presents a rare case of parapagus dicephalus dipus tribrachius conjoined twins with detailed clinical and anatomical findings.

## Key findings

- The twins shared a single heart with structural abnormalities and died of sepsis.
- Early prenatal diagnosis through ultrasound is crucial for management decisions.
- Routine second-trimester anomaly scans are lacking in the authors' setting.

## Abstract

Conjoined twins are a rare occurrence, affecting approximately 1.47 per 100,000 live births as a result of the incomplete splitting of the embryo in monochorionic monoamniotic pregnancies, after 13-14 days post-fertilization. Early prenatal diagnosis through ultrasound between 11 and 14 weeks is crucial for counseling and management decisions, including pregnancy termination or continuation with the support of a multidisciplinary team. We report a case of a 17-year-old primigravida referred in the third trimester with an ultrasound diagnosis of parapagus dicephalus dipus tribrachius conjoined twins. Delivery was by elective cesarean section, and the twins shared a single heart with three ventricles, two atria, a large atrial septal defect, and an incompetent atrioventricular valve. They died of sepsis on day 20 post-delivery. In our setting, anomaly scans during the second trimester are rarely or never performed, highlighting the need for routine early anomaly scans to enable timely intervention and improve outcomes in similar cases.