Tofu Siamese Twins Deeper: Causes, Types, Symptoms To Number Of Cases In Indonesia
JAKARTA - Approximately four hours the operating room of the Regional General Hospital (RSUD) Dr. Moewardi was enveloped in the busyness of separating two conjoined twins. The operation went well. This is the umpteenth case of conjoined twins in Indonesia. Let us now examine this rare phenomenon in the world of obstetrics-gynecology. What are conjoined twins? What are the numbers in Indonesia?
Starting at 08.00, operations ended at 11.55 WIB. After surgery, the two babies were immediately treated in the intensive room under the supervision of an intensive pediatric consultant pediatrician and a special nurse.
"Monitoring of the babies with the initials Ba and Br is carried out continuously for 24 hours until their condition is stable and ready to be transferred to the normal inpatient room," said Director of RSUD Dr. Moewardi Surakarta, Dr. Cahyono Hadi in Solo, Wednesday, April 21.
The two 14-month-old babies were born in Karanganyar with twins attached to the chest to the stomach or 'ompholapagus', with each of them having intact vital organs. According to Cahyono, monitoring of the baby's condition has been carried out by a team of doctors RUSD Dr Moewardi since they were both born.
How is the operation to separate the conjoined twins Ba and Br?This operation involves a large team. There are 18 specialist doctors, two general practitioners and nurses. Specialists involved include anesthetists, plastic surgery, pediatric surgery, cardiovascular thoracic surgery (BTKV), pediatricians and intensive pediatric consultants, and intensive care consultant anesthetist specialists (KIC).
"In addition to the operation team for the separation of conjoined twins, we also involve a pediatric psychiatrist and the medical team of Dr. Moewardi Hospital," Cahyono, quoted from Antara.
The team of doctors at Dr. Moewardi Hospital after the operation of conjoined twins (Source: Antara)
The anesthetist is responsible for the preparation process, including preparing the site and anesthesia. The plastic surgeon is tasked with making incisions from the skin to the fascia, according to the design that has been made, as well as closing the defect so that the baby is separated.
"Furthermore, two pediatric surgeons are responsible for liver and intestinal separation. Two BTKV specialists perform vascular bypass backup for baby Ba. And five pediatricians and two KIC anesthetists are in charge of pre and post surgery care."
For the other two general practitioners it is in charge of documenting the separation procedure. Cahyono explained that the operational costs are borne by BPJS Kesehatan.
What are conjoined twins?Conjoined twins are a disorder in which a pair of twins is attached to one or more body parts. In some cases, their organs are also connected.
The body parts that are most commonly joined are the head, chest, abdomen, back, and pelvis. Conjoined twins are said to be a rare condition.
This condition occurs due to incomplete division process in monozygous twin pregnancies (one egg). Although some can survive, conjoined twins have the potential to die, either in the womb or after birth.
What are the symptoms of conjoined twins?There are no specific symptoms that can be guessed by a mother when she is pregnant with conjoined twins. The complaints that occur are usually similar to that of a normal fetal pregnancy.
The mother will experience weakness, nausea, and vomiting in the early stages of pregnancy. And like pregnancies with normal twins, the uterus of conjoined twins is also enlarged faster than single fetal pregnancies.
How many types of conjoined twins are there?Quoted from Alodokter, conjoined twins are divided into several. The type is based on which part of the body or organ is connected or attached.
OmphalopagusThis type is experienced by two baby boys in Karanganyar, Ba and Br. Ompholagus is a condition of conjoined twins, in which the stomachs of both babies stick together.
Generally, conjoined twins have only one liver, one lower small intestine, and one large intestine. Ba and Br are lucky because they both have their own intact organs.
ThoracopagusWhen the baby's chest sticks together. This is the most common. The chest is the part of the body that is most often connected in the case of conjoined twins.
Generally, twins with a thoracopagus condition only have one heart, one liver and one intestine.
PygopagusThe condition of conjoined twins occurs when the baby's lower back and buttocks stick together. In the pygopagus condition, babies usually have only one digestive tract.
Their genitals are usually only one. The same number as their urinary organs.
CraniopagusCraniopagus conjoined twins is a condition when the baby's head sticks together on the side or on the top of the head.
Usually two babies only have one skull. Even so they have different and separate brains.
IschiopagusThese conjoined twins occur when the baby's pelvis is attached to each other, either facing or back to back.
ParapagusWhen the baby's pelvis, stomach, and chest are pressed against each other in a sideways position.
CephalopagusBaby faces stick together. Generally, their faces are on opposite sides of each other.
Conjoined twins with this condition generally only have one brain. It is very difficult for them to survive.
RachipagusThe spines of the two babies are stuck together. This case is very rare.
ParasiticIn this condition, one of the twins is physically smaller and not fully formed.
What causes conjoined twins? Can it be prevented?We have mentioned a little above about what are conjoined twins. Then, what is the cause? Yes, conjoined twins occur when the division of monozygous twins (one egg) is late and ultimately incomplete.
So, the division process usually occurs within eight to 12 days after the egg meets the sperm. If it is late and exceeds that time period, then the division tends to stop in an incomplete process.
That is what causes babies to be born clinging. There is also another theory that conjoined twins occur when two eggs that initially separated reunite and stick together during pregnancy.
Unfortunately, there are not many further studies on conjoined twins. Because the causes and risk factors are uncertain, conjoined twins are difficult to prevent.
The best thing you can do is carry out routine pregnancy control to monitor the health of the mother and fetus. At least routine control can help parents find out the condition of conjoined twins earlier.
The number of cases of conjoined twins in IndonesiaConjoined twins, however, are classified as a rare medical condition. The official website of Universitas Airlangga (Unair) notes the scale of the incidence ranges from 1: 50,000 to 1: 200,000 from the number of live babies.
Southeast Asia is the region with the highest number of conjoined twins in the world. Apart from Southeast Asia is Africa.
Chairman of the Center for Integrated Conjoined Twins Service (PPKST) RSUD Dr. Soetomo FK UNAIR Surabaya, Agus Harianto, explained that the ratio of conjoined twins is more dominated by women than men, with a ratio of 3: 1.
In Indonesia, the incidence continues to increase from year to year. "From 1975 to 2017, Dr. Soetomo FK UNAIR Hospital has treated more than 80 cases of conjoined twins throughout Indonesia," he said.
The handling of conjoined twins in Indonesia is very different. There are many factors and complexities to deal with. One of them is related to Indonesia's geography, which consists of thousands of islands scattered throughout the country.
Another problem is the minimal and unequal facilities and health institutions available for the treatment of conjoined twins. Poverty is also a problem.
Although the detailed relationship between economic conditions and the birth of conjoined twins is not yet known, Agus explained that most of the parents of conjoined twins are middle to lower class.
As of October 2018, out of 85 cases of conjoined twins, only 37 cases (43.5 percent) had survived. Most of the 48 cases (56.5 percent) cases of conjoined twins, the babies were not saved.
* Read other information about HEALTH or read other interesting articles from Bagus Santosa and Yudhistira Mahabharata.
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