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Though the prognosis of conjoined twins is generally low, there is limited evidence as to the optimal method of pregnancy termination, particularly in cases of advanced gestational age. We report a successful dilation and evacuation (D&amp;E) done for conjoined twins at 22\u00a0weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 20-year-old primigravid woman was diagnosed with a conjoined, thoraco-omphalopagus twin pregnancy after undergoing a detailed two-dimensional (2D) fetal ultrasound anatomic scanning. Assessment and counseling were done by a multidisciplinary team. The team discussed the prognosis and options of management with the patient. The patient opted for termination of pregnancy. Different options of termination were discussed and the patient consented for D&amp;E, with the possibility of reverting to hysterotomy in case intraoperative difficulty was encountered. A 2-day cervical preparation followed by D&amp;E was done under spinal anesthesia and ultrasound guidance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this patient, D&amp;E was done successfully without complications. Adequate cervical preparation, pain control, and ultrasound guidance during the procedure are critical for optimal outcomes. A literature review of methods of pregnancy termination for conjoined twins in the second trimester revealed 75% delivered vaginally through medical induction while 18% underwent cesarean section. Only one other report described successful D&amp;E for conjoined twins after 20\u00a0weeks. D&amp;E can be safely performed for carefully selected cases of conjoined twins beyond 20\u00a0weeks\u2019 gestations avoiding the need for induction or hysterotomy.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13256-021-02815-4","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T17:02:42Z","timestamp":1621616562000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Successful dilation and evacuation for second trimester conjoined twin: a case report and review of the literature"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2624-544X","authenticated-orcid":false,"given":"Ferid A.","family":"Abubeker","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tesfaye H.","family":"Tufa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matiyas Asrat","family":"Shiferaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mekdes Daba","family":"Feyssa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wondimu","family":"Gudu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delayehu","family":"Bekele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Prager","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,21]]},"reference":[{"key":"2815_CR1","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1046\/j.1365-2168.2002.02193.x","volume":"89","author":"L Spitz","year":"2002","unstructured":"Spitz L, Kiely E. 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