Dangerous Twins 3 Sub Download

Locked twins is a rare and hazardous obstetric complication, which occurs in approximately 1:1000 twin pregnancies. One of the known etiologic factors for locked twins is size of the twins. We report a case of chin-to-chin locked twins that occurred at gestational age of 30 weeks pus 6 days.

Dangerous Twins 3 sub download

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A 27 years-old primigravida Ethiopian mother presented with a history of pushing down pain and passage of liquor of 6 hours duration at gestational age of 30 weeks plus 6 days. With a diagnosis of twin pregnancy (first twin non-vertex), abdominal delivery was decided in latent first stage of labor but mother refused caesarian delivery and she was allowed to labor with the hope of achieving a vaginal delivery. In second stage, interlocking twin was encountered and a low vertical cesarean section was done to effect delivery of twins without the need to decapitate the first twin.

Of the different etiological factors for locked twins, the most important are the age of the mother, parity of the mother, and the size of the twins [1]. Interlocking twins are more common in primigravida as basal uterine tone may be greater in the first pregnancy resulting in stronger uterine contractions during labor [2]. This report describes a 27 years-old primigravida mother who complicated with a chin-to-chin locked twins at early 3rd trimester of pregnancy, at gestational age of 30 weeks and 6 days. Low vertical cesarean section was done that successfully effected delivery of the babies without any need of decapitation of the first twin. This is a unique surgical practice being reported in our case for the first time.

With the assessment of latent phase of labor plus twin pregnancy (DCDA) first twin in breech presentation plus early preterm pregnancy, obstetric ultrasound was done. The sonographic findings was first twin in breech presentation with estimated fetal weights of Twin A of 1200 g and twin B cephalic presentation 1100 g. The biophysical profile for both twins was reassuring. Baseline fetal heartbeat was 126 and 140 for twin A and twin B, respectively. With an indication of twin pregnancy (first non-vertex) in labor, emergency cesarean section (CS) was decided but patient refused for the CS delivery despite being thoroughly counseled repeatedly.

With an indication of locked twins Cesarean delivery was done, a low-vertical CS. First, second twin in cephalic presentation was extracted after the chin-to-chin twin interlocking was relieved manually. The attending surgeon's right hand rested on the lateral side of the second baby's face and it slipped the chin of the second twin with a gently push from the lateral side. Then, the head of the second twin was extracted cephalic by a push technique.

Twin pregnancies are at increased risk of intrapartum complications [1]. Locked twins is a rare, hazardous obstetric complication, which occurs in approximately 1:1000 twin pregnancies [2, 3]. Locked twins usually occur when the after-coming head of the first breech fetus is locked with the head of the second cephalic fetus. Of the different etiological factors, the most important are the age and parity of the mother and the size of the twins [2]. The perinatal mortality rate is in excess of 40 per cent. This is due mainly to difficulty in disengaging the two heads, with the consequent death of one or both twins [3].

Lawrence (1949) classified cases of locking into four groups according to the respective presentation of the twins. These are, in order of frequency, breech and vertex, vertex and vertex, vertex and transverse, and breech and breech. Nissen (1958) followed Lawrence's classification. In his collection a little more than two thirds belonged to the first group [4]. Our case is classified on the first group.

If the diagnosis of locked twins is made after the death of first twin, the demised baby will be decapitated, pushed upward for a safe delivery of the second fetus [7]. Our case was managed without the need of decapitation of the first twin, which was achieved by creating adequate space for manipulation by using a low-vertical uterine incision.

When locked twins occurs, cesarean section is the recommended mode of delivery. But, it should not be a hard and fast rule that extraction of the babies be achieved by decapitation of the first twin. If adequate space is created by using low vertical (like it was done in our case) or inverted T C-section, delivery of the twins can be effected without decapitation of the first twin.

The original online version of this article was revised: the authors would like to correct the approximate number of locked twins pregnancies in the Abstract under the heading Background and in the main article under the heading Discussion.

Though many conjoined twins are not alive when born (stillborn) or die shortly after birth, advances in surgery and technology have improved survival rates. Some surviving conjoined twins can be surgically separated. The success of surgery depends on where the twins are joined and how many and which organs are shared. It also depends on the experience and skill of the surgical team.

There are no specific symptoms that indicate a conjoined twin pregnancy. As with other twin pregnancies, the uterus may grow faster than it does with a single baby. And there may be more tiredness, nausea and vomiting early in the pregnancy. Conjoined twins can be diagnosed early in the pregnancy using an ultrasound.

In rare cases, twins may be conjoined with one twin smaller and less fully formed than the other (asymmetric conjoined twins). In extremely rare cases, one twin may be found partially developed within the other twin (fetus in fetu).

Identical twins (monozygotic twins) occur when a single fertilized egg splits and develops into two individuals. Eight to 12 days after conception, the embryonic layers that split to form monozygotic twins begin to develop into specific organs and structures.

As with twins, conjoined babies are likely to be born prematurely, and one or both could be stillborn or die shortly after birth. Severe health issues for twins can occur immediately, such as trouble breathing or heart problems. Later in life, health issues such as scoliosis, cerebral palsy or learning disabilities may occur.

Possible complications depend on where the twins are joined, which organs or other parts of the body they share, and the expertise and experience of the health care team. When conjoined twins are expected, the family and the health care team need to discuss in detail the possible complications and how to prepare for them.

Diagrams showing the positions of twins and the incidence of developmental dysplasia of the hip: (A) cephalic-breech, (B) breech-cephalic, and (C) breech-breech (incidences are presented as percentage and number of cases in parenthesis). Only twins with both fetuses meeting the inclusion criteria were included in these diagrams.

The strengths of this study are the relatively large twin pregnancy sample size in a single medical center and the analysis of the various presentation combinations in twins. We considered all combinations, including cephalic-breech, breech-cephalic, and breech-breech presentations, although, in this study, the order of fetuses was not found to be a risk factor for DDH.

One of the key aspects of the parts listed above is that a digital twin has to be associated with an object that actually exists: a digital twin without a physical twin is a model. Biological identical twins are created at the same time, are the same when they are created, and (for the sake of this argument) they continue to be the same as they develop and age. This concept of similarity of two things throughout development and evolution is key to the true digital twin, and for this similarity to be possible, the physical twin must also exist.

The exceptions are cases where the model and the prototype are insufficiently similar for model predictions to be reliable, so that updating the model of the prototype brings new knowledge. Prototypes are generally manufactured in small numbers and are therefore less likely to be subject to the variability associated with large-scale manufacture and so are more likely to be similar to the modelled versions. Hence it is likely that the application of digital twins to design will be fairly limited in impact.

Digital twins are of most use when an object is changing over time, thus making the initial model of the object invalid, and when measurement data that can be correlated with this change can be captured. These changes could be undesirable, for instance wear in bearings or fatigue in metal components, or they could be neutral but important, for instance variations in supplied material properties. If an object does not change much over time, or if data associated with that change cannot be captured, then a digital twin is not likely to be useful.

Digital twins can also be of benefit to fundamental science. Scientific equipment can have characteristics that affect the experimental results. These characteristics may change over time and may be difficult to evaluate directly. A digital twin approach can ensure that the uncertainty associated with the results of the experiment can include justifiable contributions from these characteristics. Reliable interpretation of scientific results requires an understanding of the uncertainties associated with experimental results, and use of a digital twin can provide accurate estimates of, and identify methods of minimising, these uncertainties.

More widely, the digital twin idea can be applied at a higher level than individual products. Industries whose specific products are too high volume to merit individual twins can benefit from a twin at the factory level. This level of twin enables management of inventory, maintenance, shift patterns and scheduling to optimise production efficiency by minimising down time and waste. The models used in such applications are generally empirical rather than physics-based. The use of real-time data to inform these models allows for improved determination of the parameters of these models, and for identifying when the parameters change which can be an early warning of the need for maintenance. 2ff7e9595c