Indian doctors have given a new lease of life to a baby girl who was born with a head attached to her stomach. They managed to remove the appendage of her parasitic twin in a complicated four-hour operation at JK Lone Hospital, in Jaipur. It was feeding off of her blood supply – depriving her of vital nutrients needed for her healthy development, surgeons said.
As well as being born with an extra head, which had no ears and eyes due to being partly developed, the infant also had a third hand. An unnamed 21-year-old woman presented herself to doctors at the Ram Snehi Hospital, in Jahazpur, after experiencing pain during her pregnancy. She was immediately referred for a sonography scan and an ultrasound and were told that she was carrying twins – but were unaware they would be parasitic.
Unlike conjoined twins, one is incompletely formed or wholly dependent on some bodily functions of the complete foetus. Cases of parasitic twins are rare and believed to account for just one per one million live births, according to medical literature. Dr Vijiyeta Garg, a gynaecologist who looked after the woman, assured the family that both mother and child could be saved. However, her 24-year-old husband, who works as a farmer, insisted that her life was a priority and the baby should come second. After a successful Caesarean section, the family were relieved that both managed to survive before the child was referred to JK Lone Hospital – 336 miles (540km) away.
The operation on April 26 proved to be a success – despite the young couple believing they would lose their first child, local reports suggest. Dr Pravin Marthur, of the hospital’s paediatric unit, said: ‘This is one of the rarest cases of parasitic twin. ‘The parents told us the mother had undergone sonography and other tests but were not told about carrying an underdeveloped twin. ‘They were shattered when they saw the baby.
We had to convince them to give us a nod for the surgery to save their daughter’s life. ‘After immediate consultation with a team of radiologist and support from assistant professors, we successfully removed the head from the viable child.’ The hospital did not charge the family for any health or surgery costs. The baby is recovering well and is being breastfed and will be discharged later this week.
Parasitic twins are usually a result of a delay in the separation of embryos during conception. They are formed when one embryo maintains a dominant development at the expense of the other.
A parasitic twin (also known as an asymmetrical or unequal conjoined twin) is the result of the processes that also produce vanishing twins and conjoined twins, and may represent a continuum between the two. Parasitic twins occur when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of the other.
Unlike conjoined twins, one ceases development during gestation and is vestigial to a mostly fully formed, otherwise healthy individual twin. The undeveloped twin is defined as parasitic, rather than conjoined, because it is incompletely formed or wholly dependent on the body functions of the complete fetus. The independent twin is called the autosite.
- Conjoined parasitic twins joined at the head are described as craniopagusor cephalopagus, and occipitalis if joined in the occipital region or parietalis if joined in the parietal
- Craniopagus parasiticusis a general term for a parasitic head attached to the head of a more fully developed fetus or infant.
- Fetus in fetusometimes is interpreted as a special case of parasitic twin, but may be a distinct entity.
- The twin reversed arterial perfusion, or TRAP sequence, results in an acardiac twin, a parasitic twin that fails to develop a head, arms and a heart. The parasitic twin, little more than a torsowith or without legs, receives its blood supply from the host twin by means of an umbilical cord-like structure, much like a fetus in fetu, except the acardiac twin is outside the host twin’s body.
The blood received by the parastitic twin has already been used by normal fetus, and as such is already de-oxygenated, leaving little developmental nutrients for the acardiac twin. Because it is pumping blood for both itself and its acardiac twin, this causes extreme stress on the normal fetus’s heart. Many TRAP pregnancies result in heart failure for the healthy twin. This twinning condition usually occurs very early in pregnancy.
A rare variant of the acardiac fetus is the acardius acormus where the head is well-developed but the heart and the rest of the body are rudimentary. While it is thought that the classical TRAP/Acardius sequence is due to a retrograde flow from the umbilical arteries of the pump twin to the iliac arteries of the acardiac twin resulting in preferential caudal perfusion, acardius acormus is thought to be a result of an early embryopathy.