Published: 2022-07-27

About a case of a specific complication of monoamniotic twin pregnancy: umbilical cord entanglement

Mouhamadou Wade, Mamour Gueye, Aissatou Mbodji, Mame Diarra Ndiaye, Mouhamet Sene, Pahté Sow, Daouda Adama Diallo, Mouhamed Nazir Sylla, Magatte Mbaye


Monoamniotic twin pregnancies are uncommon and often complicated by umbilical cord entanglement. It is important to investigate a umbilical cord entanglement during antenatal ultrasound examinations. The diagnosis is based on ultrasound with color and pulsed Doppler. Despite the high percentage of cord entanglement, the perinatal mortality rate remains very low. Rigorous ultrasound monitoring and recording of fetal heart rhythms can improve the prognosis. We report a case of umbilical cord entanglement in a monoamniotic twin pregnancy discovered during a caesarean section with a favorable outcome.


Monoamniotic twin pregnancy, Cord entanglement, Perinatal complications

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Colbum DW, Pasquale SA. Monoamniotic twin pregnancy. J Reprod Med. 1982;27:165-8.

Benirschke K. The biology of the twinning process: how placentation influences outcome. Semin Perinatol. 1995;19:342-50.

DeStephano CC, Meena M, Brown DL, Da- vies NP, Brost BC. Sonographic diagnosis of conjoined diamniotic monochorionic twins. Am J Obstet Gynecol. 2010;203:4-6.

Omari AA, Cameron D. Getting knotted: um- bilical knots in a monochorionic monoamni- otic twin pregnancy. Arch Dis Child Fetal Neonatal Ed. 2005; 90:24.

Deutsch AB, Miller E, Spellacy WN, Mabry R: Ultrasound to identify cord knotting in monoamniotic monochorionic twins. Twin Res Hum Genet. 2007;10: 216-8.

Walker SP, Cole SA, Edwards AG, Victorian Fetal Therapy S. Twin-to-twin transfusion syndrome: is the future getting brighter?. Australian, New Zealand J Obstet Gynaecol. 2007;47(3):158-68.

Emery S, Bahtiyar M, Dashe J, Wilkins-Haug L, Johnson A, Paek B, et al. The North American fetal therapy network consensus statement: prenatal management of uncomplicated monochorionic gestations. Obstet Gynecol. 2015;125(5):1236.

Pasquini L, Wimalasundera RC, Fichera A, Barigye O, Chapell L, Disk NM. High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks. Ultrasound Obstet Gynecol. 2006;28:681-7.

Baxi LV, Walsh CA. Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes. J Matern Fetal Neonatal Med. 2010;23:506-10.

Hack KE, Derks JB, Schaap AH, Lopriore E, Elias SG, Arabin B, et al. Perinatal outcome of monoamniotic twin pregnancies. Obstet Gynecol. 2009;113:353-60.

Preyer A. Physiologie de l’embryon. Trad française. 1887.

Winer N, Caroit Y, Levaillant C, Phillipe J-H. Grossesse monochoriale monoamniotique : diagnostic et prise en charge. J Gynécol Obstét Biologie Reprod. 2009;38:85-9.

Rossi AC, Prefumo F. Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature. Ultrasound Obstet Gynecol. 2013;41:131-5.

Dias T, Mahsud-Dornan S, Bhide A, Papageorghiou AT, Thilaganathan B. Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obste Gynecol. 2010;35:201-4.

Ertan AK, Schmidt W. Umbilicalcord entanglement and color coded Doppler ultrasound. Geburtshilfe Frauenheilkd. 1994;54:196-203.

Overton TG, Denbow ML, Duncan KR, Fisk NM. First trimester cord entanglement in monoamniotic twins. Ultrasound Obstet Gynecol. 1999;13:140-2.

Belfort MA, Moise KJ, Kirshon B, Saade G. The use of color flow Doppler ultrasonography to diagnose umbilical cord entanglement in monoamniotic twin gestations. Am J Obstet Gynecol. 1993;168:601-4.

Roque H, Gillen-Goldstein J, Funai E, Young BK, Lock- wood CJ. Perinatal outcomes in monoamniotic gestations. J Matern Fetal Neonatal Med. 2003;13: 414-21.

Riethmuller D, Lantheaume S, Teffaud O, Menget A, Maillet R, Schaal JP. Pronostic obstétrical et néonatal des grossesses gémellaires monoamniotiques. J Gynecol Obstet Biol Reprod. 2004;33:632-6.

Demaria F, Goffinet F, Kayem G, Tsatsaris V, Hessabi M,, Cabrol D. Monoamniotic twin pregnancies: antenatal manage- ment and perinatal results of 19 consecutive cases. BJOG. 2004;111:22-6.