The uncovered myth behind Siamese twins explored

Wed, 07 Feb 2018 11:00:43 +0000

By Edward Mwango

In African culture it was considered taboo if a woman gave birth to conjoined or Siamese twins or babies born with birth defects.

This was attributed to witchcraft in a culture shrouded in traditional norms and beliefs amid high illiteracy levels.

Little did they know that these were natural scientific occurrences which have since been explained in details by doctors and scientists worldwide.

Conjoined babies have in the recent past made headlines in Zambia and abroad mostly attracting attention and anxiety regarding the survival of the babies as they undergo an operation.

In 2015 a dark cloud hang over the solemn parents of Siamese twins, Chipepo and Cholwe who died at the University Teaching Hospital (UTH) in Lusaka where they were referred to for specialist treatment.

The babies, born on October 12th 2015 at Choma’s Batoka hospital to Christine Moono and Lasford Musanka shared a navel and their sex was not known.

The Siamese twins who were conjoined at the abdomen died around 23 hours on that fateful day which the couple will live to remember.

Previously there was a success story on Siamese twins Joseph and Luka Banda.

Joseph and Luka Banda (born January 23, 1997, in Lusaka) used to be conjoined.

They were born joined at the back of the skull and faced in opposite directions.

In 1997, Dr. Ben Carson led a team of 50 Zambian and South African specialists to separate the 11-month-old twins in a 22-hour operation.

They did not share any organs, but shared intricate blood vessels that flowed into each other’s brains.

In 2001, the twins were fitted with artificial skulls to permanently close their heads, and are neurologically normal.

Dr. Carson was quoted as saying about the operation:

“In the end, the Bandas  became the first Type 2 craniopagus twins (joined at the head and facing in opposite directions) ever separated with both surviving and both being neurologically normal.

“They are residing in a low-cost/high-density area of Lusaka in Chilenje South. “

Another success story is the recent one in which surgeons at UTH successfully separated seven-month-old conjoined twins in a landmark operation.

“A lot of progress has been made. In fact great progress, the twins have been separated. They were separated at exactly 16:58 hours.

“However, there is still a lot to be done in terms of closing up the wounds and we anticipate that the surgery will continue for an hour and a half to two hours. We hope by 20:00 hours they will be in ICU,” Dr Maureen Chisembele told journalists.

A team of 30 health professionals on February 2nd 2018 operated the twins who are joined at the abdomen and shared a liver.

The children – Bupe and Mapalo, were born in Kawambwa in Luapula Province.

And according to   Health line an on-line publication a birth defect is a problem that occurs when a baby is developing in utero (in the womb).

Approximately 1 out of every 33 babies in the United States is born with a birth defect and elsewhere.

The report states that birth defects can be minor or severe.

They may affect appearance, organ function, and physical and mental development.

Most birth defects are present within the first three months of pregnancy, when the organs are still forming.

Some birth defects are harmless. Others require long-term medical treatment.

Severe birth defects are the leading cause of infant death in the United States, accounting for 20 percent of deaths.

 What causes birth defects?

Birth defects can be a result of:

Genetics

Lifestyle choices and behaviors

Exposure to certain medications and chemicals

Infections during pregnancy

And according to Wikipedia Conjoined twins are identical twins joined in utero.

An extremely rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence in Southeast Asia and Africa.

Approximately half are stillborn, and an additional one-third die within 24 hours.

Most live births are female, with a ratio of 3:1.

Two contradicting theories exist to explain the origins of conjoined twins.

The more generally accepted theory is fission, in which the fertilized egg splits partially.

The other theory, no longer believed to be the basis of conjoined twinning, is fusion, in which a fertilized egg completely separates, but stem cells (which search for similar cells) find like-stem cells on the other twin and fuse the twins together. Conjoined twins share a single common chorion, placenta, and amniotic sac, although these characteristics are not exclusive to conjoined twins as there are some monozygotic but non-conjoined twins who also share these structures in utero.

Accordingly, the most famous pair of conjoined twins was Chang and Eng Bunker (1811–1874), Thai brothers born in Siam, now Thailand. They traveled with P.T. Barnum’s circus for many years and were labeled as the Siamese twins. Chang and Eng were joined at the torso by a band of flesh, cartilage, and their fused livers. In modern times, they could have been easily separated.

Due to the brothers’ fame and the rarity of the condition, the term “Siamese twins” came to be used as a synonym for conjoined twins.

Facts about conjoined twins as compiled by BBC

Conjoined twins develop from a single fertilized egg and are therefore always identical and of the same sex

It is unknown why the embryo does not complete the process of separating into identical twins

Records over the past 500 years have shown around 600 sets of conjoined twins survived infancy – more than 70% of these were female

 Symptoms

There are no specific signs or symptoms that indicate a conjoined twin pregnancy. As with other twin pregnancies, the uterus may grow faster than with a single fetus, and there may be more fatigue, nausea and vomiting early in the pregnancy. Conjoined twins can be diagnosed early in the pregnancy using standard ultrasound.

 How twins are joined

Conjoined twins according to Mayo Mayo Clinic of USA are typically classified according to where they’re joined, usually at matching sites, and sometimes at more than one site. They sometimes share organs or other parts of their bodies. The specific anatomy of each pair of conjoined twins is unique.

Conjoined twins may be joined at any of these sites:

Chest. Thoracopagus (thor-uh-KOP-uh-gus) twins are joined face to face at the chest. They often have a shared heart and may also share one liver and upper intestine. This is one of the most common sites of conjoined twins.

Abdomen. Omphalopagus (om-fuh-LOP-uh-gus) twins are joined near the bellybutton. Many omphalopagus twins share the liver, and some share the lower part of the small intestine (ileum) and colon. They generally do not share a heart.

Base of spine. Pygopagus (pie-GOP-uh-gus) twins are commonly joined back to back at the base of the spine and the buttocks. Some pygopagus twins share the lower gastrointestinal tract, and a few share the genital and urinary organs.

Length of spine. Rachipagus (ray-KIP-uh-gus), also called rachiopagus (ray-kee-OP-uh-gus), twins are joined back to back along the length of the spine. This type is very rare.

Pelvis. Ischiopagus (is-kee-OP-uh-gus) twins are joined at the pelvis, either face to face or end to end. Many ischiopagus twins share the lower gastrointestinal tract, as well as the liver and genital and urinary tract organs. Each twin may have two legs or, less commonly, the twins share two or three legs.

Trunk. Parapagus (pa-RAP-uh-gus) twins are joined side to side at the pelvis and part or all of the abdomen and chest, but with separate heads. The twins can have two, three or four arms and two or three legs.

Head. Craniopagus (kray-nee-OP-uh-gus) twins are joined at the back, top or side of the head, but not the face. Craniopagus twins share a portion of the skull. But their brains are usually separate, though they may share some brain tissue.

Head and chest. Cephalopagus (sef-uh-LOP-uh-gus) twins are joined at the face and upper body. The faces are on opposite sides of a single shared head, and they share a brain. These twins rarely survive.

In rare cases, twins may be asymmetrically conjoined, with one twin smaller and less fully formed than the other.

Research study indicates that 12 cases of conjoined twins from West Africa were reported between 1936 and 1978.

Eight sets were born live and were surgically separated either in local hospitals or abroad. Four were stillborn. Two new cases of stillborn conjoined twins were recently delivered at this hospital. The most common type and the ones most likely to be born alive were the omphalopagi.

Surgical separation was successful in 5 cases but the twins separated at Zaria died about a month later. Emergency operations were performed on the pygopagus and ischiopagus, and one member of the former but both of the latter died.

The thoracopagus and dicephalus twins were stillborn. However, necropsy findings in one of the thoracopagi indicate that surgical separation would have been feasible had the twins been born alive.

The internal mechanical factors causing cardiac defects in such twins may be relevant to the study of the pathogenesis of congenital cardiac malformations.

As Zambia anxiously waits for a complete sequence in the successful operation of the latest Siamese twins, the gist lies in the hands of God the creator and the men and women behind Zambia’s historic moment for the twins’ everlasting life.

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