Two pairs of Siamese twins await operation at RSCM

Muninggar Sri Saraswati, The Jakarta Post, Jakarta

The young woman was overjoyed when a midwife at a community health center (Puskesmas) in Serang, Banten, told her last year that she was pregnant.

Nuni, now 25, became even happier when she learned that she was carrying twins. She was sure the babies were healthy.

When she delivered the babies in the afternoon of April 12, however, Nuni was shocked.

"My husband told me that our daughters were Siamese twins. I was so shocked. But we realized later that we must thank God for His blessing," Nuni told The Jakarta Post at Cipto Mangunkusumo General Hospital (RSCM) on Friday. Her twins were named Ferina and Ferini.

"There was nothing unusual during my pregnancy. I received regular checkups at the Puskesmas," the housewife said.

Ferina and Ferini are now lying in their tiny beds at the RSCM infant ward with around 60 other babies. They share their fate with another pair of Siamese twins, dubbed Nunik 1 and Nunik 2, who were born on May 30 in Bogor, West Java.

Both Siamese twins were sent to RSCM for surgery to separate their bodies.

Nuni and her husband, Nurul Falah, were confused after learning about the condition of their babies. They could not afford the surgery, which would cost up to Rp 100 million (US$11,455). As a factory worker, Nurul's salary was based on the regional minimum wage of around Rp 500,000 a month.

The couples were lucky when the Nur Farida foundation learned about their difficult situation and offered financial help to cover the surgery.

"We're happy that the foundation finally offered to help as we just couldn't afford the operation. However, as time for the surgery is getting closer, I'm very afraid," Nuni said. "I really hope the surgery will be successful so I can see my daughters grow up normally."

Ferina and Ferini, who are attached at their chest and abdomen (thoraco abdominopagus), have two hearts, two lungs but only one liver and one rectum. Nunik 1 and Nunik 2 are also suffering from the same thing.

A team of doctors, who are working free-of-charge to help the Siamese twins, have conducted minor surgery for Ferina and Ferini to construct a rectum. The surgery to separate the twins is expected to take place next month. A total of 35 doctors will join the separation surgery.

Nunik 1 and Nunik 2, however, will have to wait longer as they are too young to undergo surgery.

Since 1970, RSCM has operated on 14 Siamese twins. All operations have supposedly been a success. Following the operations on both pairs of Siamese twins, RSCM will also operate on another pair of Siamese twins from Bali, who are reportedly to be flown to Jakarta soon.

"The operation to separate the Siamese twins depends mostly on the condition of the babies, particularly on their organs. The surgery is likely to succeed if each of the babies has healthy organs," said RSCM director Dr. Merdias Al Matsier.

There is no certain cause behind the birth of Siamese twins. Dr. Merdias explained it could happen due to the failure of a zygote to separate on the 13th day after fertilization.

"Siamese twins are identical twins who develop with a single placenta from a single zygote," he said, adding Siamese twins always have the same sex.

For every 40,000 births there will be one pair of Siamese twins. However, it only happens once in every 200,000 live births. Females are more likely to be Siamese twins than males, at a ratio of 3:1.

There are several types of Siamese twins based on the point at which they are attached. A pair of Siamese twins can be attached to each other at the head (craniopagus), chest (thoracopagus) or back (pygopagus).

Ferina and Ferini are of the thoracopagus type, which is the most common form of Siamese twins.