Double placenta in a singleton pregnancy: a case report

Abstract

Two placentas in singleton pregnancy with fused umbilical cord which has its own placental insertion site forming 3-vessel cord at fetal end is an extremely rare case. We present a case which describes two placentas with fused umbilical cord. A 37-year-old woman, height of 152 cm, gravida 0, para 0, conceived by IVF with ovum donation in a FET cycle with two embryos transferred, visited our clinic regularly during the antenatal period. The 1^st trimester scan at 6 weeks showed DCDA twin but at 11 weeks combined 1^st trimester screening test, the scan showed single fetus with demise of the second twin. The 1^st trimester scan and anomaly scan did not reveal any double placenta. Later the ultrasound showed the second twin to have become a re-absorbed vanishing twin with single placenta only. The last ultrasound scan done for estimating the growth of the fetus and doppler velocimetry suddenly started showing large for date fetus. The patient was normotensive, non proteinuric and without any medical comorbidities throughout her antenatal period. We did Oral glucose tolerance test at every trimester to rule out diabetes mellitus. Serial growth scans done at 28, 30, 32 and 34weeks all showed the fetus to be large for gestational age. At 37 weeks and 4 days, the patient delivered a viable female infant weighing 3100 g via caesarean section and postpartum examination of the placentas and membranes showed two placentas with fused umbilical cord. Two placentas were almost equal in size and there were 2 cord insertions, 1 into each placenta. The cord at each of the placental disc had marginal insertion site and main placental disc cord had 2 arteries with one vein (3 vessel-cord) whereas side placental disc cord had one artery with one vein (2 vessel-cord).