Neonatal outcome of dicephalus parapagus twins with a shared heart: A case report and review of prognostic factors

Conjoined twins are a rare type of monoamniotic twins, occurring in 1.47 per 100,000 births worldwide. Prognosis depends on the extent of organ sharing, particularly the heart. We report a case of parapagus dicephalus tribrachius dipus conjoined twins diagnosed at 19 weeks in a 24-year-old Saudi woman. Ultrasound showed twins with two heads, four upper limbs, two lower limbs, and sharing major organs. Fetal echocardiography showed one structurally normal heart and another small heart with a single outflow tract. A cesarean section was performed at 33 weeks of gestation, delivering cyanosed twins who died 53 minutes after birth. Parapagus dicephalus twins are among the most common forms of conjoined twins and carry a high risk of perinatal mortality, especially when a single functional heart is shared. Early prenatal diagnosis, multidisciplinary counseling, and discussion of management options, including termination when appropriate, are crucial for guiding parental decisions and optimizing care.