Locked Twins in a Primigravida: A Rare Obstetric Emergency Successfully Managed by Cesarean Section—A Case Report

Abstract

Background and Aims: Locked twins are a rare and life-threatening obstetric complication, occurring in approximately 1 in 1000 twin pregnancies, most commonly during labor when the first twin presents as breech and the second as cephalic. This condition poses significant risks to both the mother and fetuses if not promptly recognized and managed. We report a rare case of chin-to-neck locked twins and highlight the importance of early diagnosis and meticulous intraoperative management. Methods: A 20-year-old primigravida at 9 months of amenorrhea presented with pushing down pain for 12 h and ruptured membranes for 4 h. Clinical examination revealed a twin pregnancy with the first twin in breech presentation and a fetal heart rate of 98-100 beats per minute, while the second twin was in cephalic presentation with a fetal heart rate of 136-138 beats per minute. An emergency cesarean section was performed. Intraoperatively, a chin-to-neck interlocking of the twins was identified. Both twins were successfully delivered through the lower segment transverse uterine incision and careful intraoperative disimpaction without intraoperative complications. Results: The first twin was a male weighing 1600 g with Apgar scores of 5 and 7 at 1 and 5 min, respectively, and died 1 h postpartum due to respiratory failure related to prematurity and with a possible contribution from intrapartum hypoxia associated with interlocking of the twins. The second twin was a female weighing 1800 g with Apgar scores of 7 and 9, who required brief neonatal intensive care for respiratory distress syndrome and subsequently recovered well. The mother had an uneventful postoperative course. Conclusion: This case underscores the critical importance of early recognition of locked twins, timely surgical intervention, and careful intraoperative techniques to minimize maternal and fetal morbidity and mortality. Vigilant antenatal surveillance and preparedness in high-risk twin pregnancies are essential to prevent catastrophic outcomes associated with this rare obstetric emergency.