Conjoint twins (CTs) are a very rare entity since it occurs only once in 50,000 to 2 lakh births. Female:male CTs are 3:1. Conjoint twins are monozygotic twins. In this sense, they share the same zygote where the twinning is initiated after 12 days of fertilization of egg. It may be due to genetic or environmental factors; 40% of CTs are stillborn and an additional one-third die within 24 hours of birth. We report an undiagnosed case of ischiopagus-tetrapus CTs delivered vaginally, with difficulty needing bilateral episiotomy. The bodies of two fetuses were fused laterally from mid-abdomen to pelvis along with single umbilical cord. There were two heads, four separate limbs, with fusion at pelvic region, and partially fused male external genitalia. The CTs were cyanosed and stillborn. Postnatal period was uneventful.
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