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A patient referred with ruptured membrane was found, by ultrasound and magnetic resonance imaging, to be carrying conjoined thoracoadbominopagus twins. Two live male babies joined at the chest were delivered by caesarean section. The parents refused a separation operation and the twins died from cardiopulmonary arrest after 18 hours. A review of the literature suggests that early diagnosis by a combination of ultrasound and MRI is essential to management, providing prognosis for viability and success of surgical separation and the opportunity for early counselling of parents and termination if indicated.
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