Delivery room resuscitation of conjoined twins

OBJECTIVE: Describe the golden hour and hospital outcomes of conjoined twins METHODS: Retrospective single center study of conjoined twins. Main outcome measures included delivery room characteristics. Secondary outcomes included survival and length of stay. RESULTS: From 2013-2025, there were 19 sets of conjoined twins (active resuscitation in 13; palliative in 6). Respiratory interventions in the delivery room were frequently needed including continuous positive airway pressure (75%), positive pressure ventilation (67%), and endotracheal intubation (25%). There were two sets with emergency separation, each with one surviving twin. For the 10 sets who underwent separation, survival at NICU discharge was 80% (twin A) and 100% (twin B). CONCLUSION: The delivery room resuscitation of conjoined twins is complex with high rates of advanced respiratory intervention. These deliveries necessitate an experienced multidisciplinary team and an individualized delivery plan based on specific anatomy and reinforced with simulation. Survival is high among twins who undergo separation.