Twin Pregnancy Complicated by Chin-to-Chin Interlocking: A Case Report

Abstract Background: The complications and management of twin pregnancies have been widely studied. One of the rare complications in twin pregnancies is locked twins which occur during labor when the after-coming head of the first breech fetus is locked with the head of the second cephalic fetus. It has an incidence of 1 in 1000 twin deliveries or 1 in 90,000 deliveries and is associated with astillbirth rate of 50% for the first twin. The risk factors are age, parity of the mother and size of the twins. A large pelvis with relatively small infants and decreased liquor volume following the rupture of membranes are thought to be factors that favor interlocking. Case Summary: We present a case of 22-year-old primigravida woman from Ethiopia who came to our hospital from another institution by referral on 26/10/2024 with a diagnosis of interlocked twin in second stage of labour for better management after an unsuccessful attempt at vaginal delivery. Physical examination and investigations were performed and the patient delivered live female second twins via caesarean delivery and freshly died female neonate vaginally. The surgery was uneventful and the patient had a smooth post operative period. The second twin was managed for asphyxia at the neonatal intensive care unit and was discharged after one week of stay. Conclusion: Quality antenatal care, Counseling, early recognition of high-risk patients and early referral for better setup are very important. In cases of twin pregnancies with first nonvertex and second vertexes, locked twins should be prevented and if they occur, appropriate actions must be taken early to prevent maternal and fetal morbidity and mortality.