Chilean doctors separate conjoined twins

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In this image taken from a video released by Luis Calvo Mackenna hospital, Roberto Paredes, right, kisses his daughter Maria Jose, one of two conjoined twins after she was separated from her sister Maria Paz at the Luis Calvo Mackenna hospital in Santiago, Chile, Wednesday, Dec. 14, 2011. The 10-months-old twins were joined at the chest, stomach and pelvis. (AP Photo/Luis Calvo Mackenna Hospital) In this image taken from a video released by Luis Calvo Mackenna hospital, Roberto Paredes, right, kisses his daughter Maria Jose, one of two conjoined twins after she was separated from her sister Maria Paz at the Luis Calvo Mackenna hospital in Santiago, Chile, Wednesday, Dec. 14, 2011. The 10-months-old twins were joined at the chest, stomach and pelvis. (AP Photo/Luis Calvo Mackenna Hospital) In this image taken from a video released by Luis Calvo Mackenna hospital, Roberto Paredes, right, caresses his daughter Maria Jose, one of two conjoined twins after she was separated from her sister Maria Paz at the Luis Calvo Mackenna hospital in Santiago, Chile, Wednesday, Dec. 14, 2011. The 10-months-old twins were joined at the chest, stomach and pelvis. (AP Photo/Luis Calvo Mackenna Hospital) In this image taken from a video released by Luis Calvo Mackenna hospital, medical personnel work around one of two conjoined twins after they underwent surgery to be separated at the Luis Calvo Mackenna hospital in Santiago, Chile, Wednesday, Dec. 14, 2011. The 10-months-old twins were joined at the chest, stomach and pelvis. (AP Photo/Luis Calvo Mackenna Hospital)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); SANTIAGO, Chile (AP) — Chilean doctors successfully separated conjoined twin girls in a marathon 20-hour surgery, saying Wednesday that the operation went extremely well despite challenges.

The 10-month-old twins Maria Paz and Maria Jose were recovering in an intensive care unit, and doctors said the next two days would be critical as they watch for infections or other possible complications.

Parents Jessica Navarrete and Roberto Paredes kept an anxious vigil at Luis Calvo Mackenna Hospital in Santiago as doctors separated the twins at the thorax, abdomen and pelvis. It was the seventh and most complex operation yet for the twins.

Doctors successfully separated the twins late Tuesday night. Chief surgeon Francisco Ossandon described it as the moment "the girls finished the process of being born."

"Before, they had two souls and one body," Ossandon said.

Surgery on one of the twins was completed early Wednesday after a total of 19 hours, while for the other it took more than 20 hours.

"We had a number of difficulties during the surgery. There were some surprises, but we were able to fix, solve the problems," Ossandon said at a news conference.

He added that the twins came out of the surgery in good condition. Ossandon, however, didn't rule out future complications involving the effects from anesthesia and possible infections.

"We're very happy because we think they've had the best evolution we could have hoped for," he said.

The girls' parents appeared in televised images as they kissed the twins before the operation. Then afterward, the mother and father gazed lovingly at the sleeping girls from beside their separate cribs in the intensive care unit.

Paredes softly placed a hand on one daughter's head.

Some Chilean television stations occasionally broke into their regular programming to broadcast updates from the doctors, both during and after the delicate surgery.

"The next 48 hours will be the most critical in terms of the ... risk they face of dying," said Dr. Carlos Acuna, chief of the intensive care unit. He said the girls faced risks of various organs ceasing to function, and also had kidney and lung problems.

The girls' mother said she was hoping for a miracle when the high-risk operation began Tuesday morning.

The Chilean twins presented a particularly difficult challenge because they were born sharing many of the same internal organs and even urinary system. About 100 people participated in the procedure, including 25 surgeons and anesthesiologists.

Perhaps providing some comfort to the parents was the hospital's history with conjoined twins. Staff there have separated three sets before. A fourth set, however, died during surgery due to cardiac complications.

According to the University of Maryland Medical Center, roughly one out of every 200,000 live births worldwide results in conjoined twins. The overall survival rate is between 5 percent to 25 percent, depending on various factors, including where they are joined.

While rare, such surgeries have become increasingly frequent over the years due to improvements in surgery, anesthesia and critical care, said Dr. Eric Strauch, a surgeon at the University of Maryland Medical Center.

"We've gotten better at dealing with them," Strauch said. "I think people are willing to undertake it more."

He said he has performed surgeries on two sets of twins. The first set, girls from Uganda, survived in 2002 and are now about 10 years old, he said.

"The second set survived for about six months after the separation, but they both succumbed to infection," said Strauch, adding that their intestines were unable to function.

He said he knew of another successful case in which two girls were separated and have reached adulthood.

"They're in their 20s and they're just graduated from college," Strauch said. "A lot of them don't do well, but a lot of them do."

Dr. Steven Fishman, a pediatric surgeon at Children's Hospital Boston, said that if twins make it out of the hospital without post-surgery complications, most tend to survive.

"If they're felt to be well enough to go home, in general they will make it long term," he said.

The Chilean twins were born in the Villarrica hospital about 470 miles (760 kilometers) south of Santiago and were kept under constant medical care, surviving with the aid of an artificial respirator.

Earlier this year, doctors separated the twins' legs, urinary tracts, pulmonary systems and other parts of their bodies. They now each have part of a leg that used to be fused together.

During the latest surgery, doctors managed to separate an intestine that had been shared by the two, giving each of them part of it, said Jaime Manalich, the government's health minister, who visited the family at the hospital.

Surgeons weren't able to completely close their abdominal cavities or their thoraxes, and therefore had to use meshing to cover them, Ossandon said. "These are foreign bodies that sometimes the body recognizes as foreign, and that can cause infections," he said.

Maria Jose was the first twin to reach the intensive care unit after the surgery. Her sister Maria Paz, whose operation was more complex due to difficulties in the area near her heart, arrived an hour and 15 minutes later.

They were born in February, and since then have been hospitalized and attached to machines including an artificial respirator.

The girls were still connected to a respirator on Wednesday.

They are to remain sedated for at least three days.

Ossandon said the twins will return to the operating room every two or three days so that doctors can clean their wounds. He called the surgery their "rebirth."

___

Associated Press writer Ian James in Caracas, Venezuela, contributed to this report.

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More US women having twins; rate at 1 in 30 babies

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ATLANTA (AP) — The number of twins born in the U.S. soared over the last three decades, mostly the result of test-tube babies and women waiting to have children until their 30s, when the chances of twins increase.

In 2009, 1 in every 30 babies born in the U.S. was a twin, an astounding increase over the 1 in 53 rate in 1980, according to a government report issued Wednesday.

"When people say it seems like you see more twins nowadays, they're right," said Joyce Martin, an epidemiologist who co-authored the Centers for Disease Control and Prevention report.

Some increase was expected as more women are delaying starting a family until they are over 30. For some unknown reason, mothers in their 30s are more likely to have twins than younger or older women. As much as a third of the increase can be attributed to that, Martin said.

The rest of the rise is due to fertility drugs and treatments.

"You have a double whammy going on. There are more older moms and more widespread use of fertility-enhancing therapies," Martin said.

Starting in the early 1980s, couples who had trouble conceiving began to benefit from medical advances like fertility drugs and in vitro fertilization and other procedures. These treatments became fairly widespread in the 1990s but are expensive, and availability and insurance coverage varies.

The twin birth rate rose by more than 2 percent a year, on average, from 1980 through 2004. It leveled off to less than 1 percent annually although the rise from 2008 to 2009 was nearly 2 percent.

In 2009, twin rates increased in all 50 states, though the jumps were highest in lower New England, New Jersey and Hawaii. In Connecticut, twins now account for nearly 5 percent of births.

That's high. Nationally, 3.3 percent of all births were twins in 2009, up from 2 percent in 1980.

Over the last three decades, rates rose for white, black and Hispanic women, but the increases were not uniform. Rates doubled for whites, rose by half for blacks and by about a third for Hispanics. Historically, black moms have twins most often, but white moms have almost caught up.

"That's changed with infertility treatments," said Barbara Luke, a Michigan State University expert on twin births.

The greatest increase in twin rates was for women 40 and older. They are more likely to use fertility treatments and to have two embryos implanted during in vitro fertilization, whereas younger women are more likely to get just one.

About 7 percent of all births for women 40 and older were twins, compared to 5 percent of women in their late 30s and 2 percent of women age 24 or younger.

While a lot of attention is focused on the impact of fertility treatments, that's not the only factor. Before fertility treatments existed, about 2.5 percent of the babies born to women in their late 30s were twins, compared to under 2 percent for younger and older women. Some research has suggested women in that age group are more likely to produce multiple eggs in a cycle, increasing their chances of twins.

Clearly, there are more older moms. In recent years, more than a third of all births have been to women 30 and older, up from just one-fifth in 1980.

Take Victoria Jacobson. At 31, she gave birth to twin girls last April — her first children. With no history of twins in her family, and no fertility drugs, it was a big surprise when she found out at six months pregnant.

"I cried, because I'm more of a realist. My husband laughed," said Jacobson, of Glen Ellyn, Ill. "They were not tears of joy. Maybe shock, more than anything."

Still, Jacobson doesn't find the new report on twin births surprising. A good friend had twins four months after Jacobson's girls were born. "I'm stopped at every corner and in every store" by mothers who also have twins, or who know of other twins, she says.

"I never knew how many twins were around until I got twins."

Are more twins good news? Some experts say the trend is worrisome, noting that multiple births are more dangerous for the mother and their babies. The infants tend to be born earlier, smaller and weaker, and require much more care.

Jacobsons' twins arrived a month early and were tiny, about 3 pounds each. They had to be cared for in a hospital intensive care unit, and one needed a ventilator at first to help her breathe.

At 8 months, they are still small, but healthy and doing fine. Still, they don't sleep through the night, and breastfeeding two and getting them on the same schedule hasn't been easy, she said.

Despite the challenges, she has this advice to other moms of twins: Don't "think about it as double trouble. It's still a double blessing."

___

AP Medical Writer Lindsey Tanner in Chicago contributed to this report.

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CDC report: http://www.cdc.gov/nchs/

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More scans urged for unborn twins

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28 September 2011 Last updated at 00:35 GMT By Helen Briggs Health editor, BBC News website Twins in the womb at 32 weeks Women expecting twins or triplets should be offered closer monitoring, including extra scans, according to new NHS guidelines.

Health watchdog NICE has drawn up recommendations for antenatal care in multiple pregnancies, amid evidence standards vary in England and Wales.

Mothers-to-be should be referred to specialist teams and receive a minimum of six scans, says NICE.

Charities say the guidelines will give mothers reassurance about their care.

Multiple births are on the rise, due mainly to an increase in the number of couples having IVF. They now account for 3% of births.

Until now, there have been no clear guidelines for women expecting twins or triplets in England and Wales, leading to differences in care, including the number and timing of scans, planned delivery dates, and the use of measures, such as bed rest, to prevent early labour.

Dr Fergus Macbeth, director of the centre for clinical practice at The National Institute for Health and Clinical Excellence (NICE), said: "We know there is a real clinical need for this guideline because NHS antenatal care for women expecting twins or triplets appears to vary considerably across England and Wales.

"For example, not all women with multiple pregnancies are cared for in dedicated settings such as 'twin clinics' or by multidisciplinary teams of healthcare professionals.

"This can lead to higher than necessary rates of assisted birth and Caesarean sections and also means that women are not appropriately assessed for possible risks during pregnancy.

"Although many women will have a normal pregnancy and birth, it is well known that there are higher risks involved for these types of pregnancy and so it is important to get it right."

Multi-disciplinary approach

The guidance says women expecting twins or triplets should receive at least six scans, and sometimes as many as 11.

A scan should be carried out at between 11 and 14 weeks to assess whether twins share a placenta, which can increase the risk of complications.

NICE said women at risk of going into labour early should not be routinely offered bed rest or drugs to prevent labour as there was no evidence that they work.

Continue reading the main story The risk of stillbirth or having a premature birth is higher in multiple pregnanciesSome risks are associated particularly with babies sharing a placentaSlow growth in the womb and congenital abnormalities are also more commonSource: NICEIn addition, the guidelines provide recommendations on when a planned birth should be offered.

They do not look at women who are pregnant with four or more babies.

Dr Virginia Beckett, from the Royal College of Obstetricians and Gynaecologists, welcomed the guidelines. She said increased monitoring and contact with healthcare workers would help ensure the mother and their babies received the best care possible.

"A multi-disciplinary approach including input from midwives, obstetricians and ultrasonographers will help ensure any complications are picked up early," she said.

Jane Denton, director of the Multiple Births Foundation, said: "Although much of the care at present is very good, there are many inconsistencies and often poor co-ordination between healthcare professionals if mothers are referred to other hospitals.

"These recommendations address all of these concerns and will give mothers confidence that they are receiving the highest standard of care, appropriate to their individual needs."

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Doctors separate conjoined twins

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18 September 2011 Last updated at 10:36 GMT The twins do not appear to have suffered neurological side effects as a result of surgery Twins who were born joined at the head have been successfully separated by a team of British doctors.

Baby girls Rital and Ritag Gaboura, who are 11 months old, were separated on 15 August after four operations at Great Ormond Street Hospital for Children.

They do not appear to have suffered neurological side effects. Only one in 10 million sufferers survive their rare condition.

The Sudanese infants were flown to the UK by the charity Facing the World.

Conjoined twins are very rare and only 5% of conjoined twins are craniopagus, which means they are fused at the head.

About 40% of twins fused at the head are stillborn or die during labour and a third die within 24 hours.

Continue reading the main story

We are very thankful to be able to look forward to going home with two separate, healthy girls”

End Quote Parents of the twins The nature of the twins' condition meant significant blood flowed between their brains.

Ritag supplied half her sister's brain with blood whilst draining most of it back to her heart. It was a life-threatening situation because significant drops in brain blood pressure would cause neurological damage.

The children were born by Caesarean section in Khartoum, Sudan.

The girls' parents, who are both doctors, said: "We are very thankful to be able to look forward to going home with two separate, healthy girls. We are very grateful to all the doctors who volunteered their time and to Facing the World for organising all the logistics and for paying for the surgery.

The parents have expressed immense gratitude for the work carried out by the doctors

"We feel very lucky that our girls have been able to have the surgery that they needed, but we also know of other children who need complete sponsorship and families who are searching for someone to help them."

So far, the girls are reacting in the same ways to tests and stimuli as they did prior to surgery which suggests they have not suffered neurological side effects.

However, their young age makes it difficult to determine whether this is definitely the case.

David Dunaway, from the plastic surgery and craniofacial unit at Great Ormond Street, was the lead clinician and is also a trustee of Facing the World.

He said: "The incidences of surviving twins with this condition are extremely rare. The task presented innumerable challenges and we were all very aware of our responsibilities to the family and these two little girls.

"The Gaboura family have been extremely brave throughout a very stressful journey and their love for their children is clear to see. It is a testimony to the support of the British public that we are able to do any of the charity work that we do."

Facing the World is funded by donations from members of the public.

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British surgeons separate very rare conjoined twins

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By Kate Kelland

LONDON | Sun Sep 18, 2011 1:26pm EDT

LONDON (Reuters) - Surgeons at a British hospital have successfully separated conjoined twin baby girls in a complex and extremely rare operation, the charity that funded the surgery said on Sunday.

Sudan-born Rital and Ritag Gaboura are craniopagus twins, meaning they were born joined at the head.

Conjoined twins are very rare and only around 5 percent of them are craniopagus. Experts say around 40 percent of those are stillborn or die during labor, and another third die within 24 hours. So for craniopagus twins to survive even beyond early infancy is a one in 10 million occurrence.

Rital and Ritag, who will celebrate their first birthday next week, were so-called Total Type III Craniopagus twins, meaning that significant blood flowed between their brains -- presenting surgeons with a particularly difficult challenge.

According to doctors who worked on the case, Ritag supplied half her sister's brain with blood, whilst draining most of it back to her heart, therefore doing most of the work.

This situation was life threatening because large dips in brain blood pressure can cause several neurological damage.

"The incidences of surviving twins with this condition are extremely rare," said David Dunaway, a surgeon in the plastic surgery and craniofacial unit at Great Ormond Street Hospital who led the separation of the girls.

"The task presented innumerable challenges."

The separation of the twins was completed on August 15, and the medical team say the twins do not appear to be suffering any neurological side effects, according to British charity Facing the World, which funded the treatment.

The twins were born in Khartoum, Sudan in September 2010 and their parents -- both doctors -- asked the charity to organize and fund their separation.

The family flew to London in April, when Ritag's heart was starting to fail, and the twins were admitted to Great Ormond Street, a world-renowned children's hospital in central London.

The separation was carried out in four stages by a surgical team who worked for free. Two operations were carried out in May, then another was undertaken in July to insert tissue expanders, and the final separation was completed on August 15.

"Within days the twins were back on the general ward interacting and playing as before. Their laughter and delight in the world has been an inspiration throughout the months of worry," the charity said in a statement.

"Very soon, their parents will be able to fulfill their dream of taking home two healthy, separate daughters.

The twins' parents, Abdelmajeed and Enas Gaboura, said in a statement: "We are very thankful to be able to look forward to going home with two separate, healthy girls."

(Editing by Myra MacDonald)

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Doctors separate conjoined twins

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18 September 2011 Last updated at 10:36 GMT The twins do not appear to have suffered neurological side effects as a result of surgery Twins who were born joined at the head have been successfully separated by a team of British doctors.

Baby girls Rital and Ritag Gaboura, who are 11 months old, were separated on 15 August after four operations at Great Ormond Street Hospital for Children.

They do not appear to have suffered neurological side effects. Only one in 10 million sufferers survive their rare condition.

The Sudanese infants were flown to the UK by the charity Facing the World.

Conjoined twins are very rare and only 5% of conjoined twins are craniopagus, which means they are fused at the head.

About 40% of twins fused at the head are stillborn or die during labour and a third die within 24 hours.

Continue reading the main story

We are very thankful to be able to look forward to going home with two separate, healthy girls”

End Quote Parents of the twins The nature of the twins' condition meant significant blood flowed between their brains.

Ritag supplied half her sister's brain with blood whilst draining most of it back to her heart. It was a life-threatening situation because significant drops in brain blood pressure would cause neurological damage.

The children were born by Caesarean section in Khartoum, Sudan.

The girls' parents, who are both doctors, said: "We are very thankful to be able to look forward to going home with two separate, healthy girls. We are very grateful to all the doctors who volunteered their time and to Facing the World for organising all the logistics and for paying for the surgery.

The parents have expressed immense gratitude for the work carried out by the doctors

"We feel very lucky that our girls have been able to have the surgery that they needed, but we also know of other children who need complete sponsorship and families who are searching for someone to help them."

So far, the girls are reacting in the same ways to tests and stimuli as they did prior to surgery which suggests they have not suffered neurological side effects.

However, their young age makes it difficult to determine whether this is definitely the case.

David Dunaway, from the plastic surgery and craniofacial unit at Great Ormond Street, was the leed clinician and is also a trustee of Facing the World.

He said: "The incidences of surviving twins with this condition are extremely rare. The task presented innumerable challenges and we were all very aware of our responsibilities to the family and these two little girls.

"The Gaboura family have been extremely brave throughout a very stressful journey and their love for their children is clear to see. It is a testimony to the support of the British public that we are able to do any of the charity work that we do."

Facing the World is funded by donations from members of the public.

View the original article here

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