Conjoined Twins With Only Two Legs to Be Delivered

LOMA LINDA —  Doctors are preparing for today’s scheduled delivery of conjoined twin girls who have an extremely rare type of the abnormality and may not be separable even if they survive birth.

The twins, named Gabrielle and Micheala, face the same direction and are joined side-by-side from the waist down. They share two legs but just one liver, kidney, intestine and bladder. Their separate spinal cords come together at the tailbone within a shared pelvis.

Should they survive their birth by caesarean section, the daughters of a Barstow couple will face surgery within a week to correct a problem with their bowel, which is believed to be obstructed or perforated, doctors say. In a best-case scenario, separation of the twins would not occur for a year--and doctors admit they are not sure it can be done.

“Given the complexity of their anatomy, we may not be able to reasonably recommend separation,” said Dr. Gerald A. Nystrom, chief of neonatology at the Loma Linda University Children’s Hospital. “We don’t see what truly good solutions are going to come from this birth.”

Pediatric surgeon Dr. H. Gibbs Andrews added that there never has been a successful separation of twins “joined in this fashion.” Even if separation is attempted, “there is extraordinary risk of attempting to separate vital organs--and if that fails, of losing one or both” of the girls, Nystrom said.

The twins’ father, Angel Garcia, said he and their mother, Karen Crowe, are prepared for any outcome. The couple learned of the situation in the 13th week of Crowe’s pregnancy, which is now in its 37th week.

“The news was devastating,” Garcia said of the conjoined fetuses. “I asked, ‘Why, why me? Was it something I did wrong? But God’s grace is sufficient for me and my wife. We just want God’s will to be done.

“If they don’t have life here, they’ll have it somewhere else,” Garcia said. “If they are absent from their human body, they will have life with God.”

He said the couple never considered abortion. “God considers it life,” he said. “Blood is life, regardless of its form. How could you even consider abortion?”

The couple also are parents of a 14-month-old daughter.

The twins are scheduled to be delivered this morning at the Loma Linda University Children’s Hospital, where in 1996 another set of conjoined twins was born and later successfully separated. Those twins, however, were joined only at the abdomen, and shared a liver that was divided between them with relative ease.

Among the immediate concerns today will be whether the girls’ shared vascular system can sustain both of them once they are taken from the womb. Prenatal testing indicates that one twin has about twice the blood flow her sister has, and the doctors said they were not sure what would happen once the umbilical cord is clamped after delivery.

Noting that one conjoined twin could not survive without the other, and that one of the babies might not receive enough blood after birth, “there is the possibility these twins won’t survive,” Nystrom said.

Doctors said Crowe had an otherwise uneventful pregnancy; the twins now weigh a total of 10 pounds.

The doctors said that although prenatal testing has provided many clues to what they can expect when the babies are delivered, critical issues will remain unknown until today.

“Until now, we’ve been looking through a keyhole,” said Nystrom. “Tomorrow, we open the door.”

Among the first questions to be resolved, the doctors said, is the integrity of the girls’ intestinal tract, whether it can sustain both girls and whether it ultimately could somehow be separated.

Conjoined twins, sometimes called Siamese twins, occur about once in every 40,000 pregnancies, and about once in 200,000 live births, according to medical statistics. About 5% of conjoined twins are attached to each other in about this way, according to the March of Dimes Birth Defects Foundation. Doctors at Loma Linda said the specific complexities of this case make it even more rare.

The term Siamese was created by the Barnum & Bailey Circus to promote its exhibition of Chang and Eng Bunker, conjoined twins born in Siam in 1811, who lived to the age of 63.