Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review.

After an unsuccessful midwife-assisted delivery in which a head was born but delivery could not be advanced, episiotomy performed at Sanliurfa Maternity Hospital allowed vaginal delivery of female conjoined twins. Visual and x-ray examination showed two heads, two vertebral columns, two feet, two arms, and fusion at the level of the pelvis. The baby was born dead, but the mother made an uneventful recovery. Parapagus (anterolaterally joined) dicephalus (two-headed) twins account for only 11-13% of all conjoined twins, and they rarely survive. Complex malformations of hearts, lungs and abdominal organs, duplication of the tracheae, upper gastrointestinal tract and spinal column, and either double or single versions of other organs have been reported in parapagus dicephalus cases. The incidence, anatomical, embryological, diagnostic, prognostic, obstetrical, perinatal, and ethical aspects of conjoined twins are reviewed, with a focus on parapagus dicephalus conjoined twins.