TITLE:
Conjoined Twins in Rural Cameroon: Diagnostic Success, Referral Failure: A Case of Thoraco-Omphalopagus Twins and the Challenges of Complicated Obstetric Care in a Remote Setting
AUTHORS:
Manfo Agoumwa Alex Giraud, Kimeze Elio Comarin, Nzometia Crysantus Yimlefack, Forchap Nkemanjong Milton, Kenfack Kelly Flora, Theophile Nana Njamen
KEYWORDS:
Conjoined Twins, Thoraco-Omphalopagus, Low-Resource Setting, Referral Delay, Cameroon
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.16 No.9,
September
10,
2026
ABSTRACT: Background: Conjoined twins are a rare congenital anomaly arising from incomplete embryonic division, associated with high rates of stillbirth and early neonatal death, particularly in low-resource settings where specialized obstetric and neonatal services are limited. Case: We report a case of thoraco-omphalopagus conjoined twins diagnosed antenatally at 15 weeks of gestation in a 21-year-old multiparous woman with HIV infection on antiretroviral therapy, residing in a rural district of Cameroon. Although the diagnosis was confirmed by ultrasound at a regional hospital and the patient was referred for specialized follow-up at a tertiary institution, she was lost to follow-up and re-presented several weeks later in spontaneous labor at a peripheral health center. She was referred again as an obstetric emergency and delivered by cesarean section for obstructed labor, yielding live male conjoined twins sharing a single placenta, with ventral fusion of the thorax and abdomen. The neonates remained clinically stable for approximately 36 hours awaiting transfer, but referral was delayed by the absence of a functional neonatal transport system, and both infants died during an 11-hour transport to the tertiary center. Conclusion: This case illustrates how early antenatal diagnostic success can be undermined by fragmented referral pathways, loss to follow-up, and inadequate neonatal transport infrastructure. Strengthening active follow-up of high-risk pregnancies, pre-emptive referral before delivery, and equipping neonatal transport systems are essential to improving outcomes for conjoined twin pregnancies in low-resource, remote settings.