By Dominique Herman
A Somerset West woman, who did not know she was carrying twins, gave birth to conjoined twins just over a month ago, shortly after which one twin died and emergency surgery was performed to separate the babies.
There is a one in 200 000 incidence of conjoined twins.
Since 1964 at the Red Cross Children's Hospital - where the babies were brought at 8.30pm on the day they had been born and where the emergency surgery was performed the next morning - they have had 41 cases of conjoined twins, of which 30 have been separated.
Brenda Willemse checked into Hottentots Holland hospital at 5.45am on June 29 and at 3pm a cesarean section was performed.
When the doctor asked her if she knew what Siamese twins were, she got a fright, she said, because her impression of Siamese twins was that they were attached at the head. In fact, Brenda's twins were joined at the pelvis.
"We had never seen one like this," said Professor Heinz Rode, head of paediatric surgery at Red Cross, who added there were eight commonly diagnosed variations on conjoined twins and these ones were a combination of two.
They shared a diaphragm, liver, bladder, the large bowel and a "tremendous amount of skin", according to Rode. There were two spinal columns and each baby had only one leg.
Rode said they kept the lower half of the lumbar spine of the dead baby, along with its leg, which was not functioning but was still viable.
He said that hopefully the deformity in the spine of the surviving twin, Ashton, would correct itself in time - there had already been a 10 percent improvement - although he was not sure if the spine would ever completely straighten. In due course Ashton will undergo cosmetic, orthopaedic and spinal operations, but because Rode was expecting a lot of "spontaneous correction" they would play it "month by month".
The other twin was dead for 12 hours before the emergency surgery was performed. Usually a separation surgery takes longer to plan, but, because the one baby was dead already, they had to minimise the amount of toxic substances that were cross circulating through the blood to Ashton. Having the early surgery saved Ashton's life, Rode said.
Brenda had one antenatal scan during her pregnancy, three weeks before her due date, during which only one, "strong" heartbeat was heard.
Rode said that not detecting that she was having twins was an "oversight" on the part of whoever had performed the scan, but the outcome would not have been different had the baby been delivered at the Red Cross or Tygerberg hospitals.