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Vaginal delivery of monoamniotic twins with umbilical cord entanglement. A case report
1Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
Background:
Monoamniotic twinning is frequently complicated by umbilical cord entanglement and fetal death. Should vaginal delivery take place, this may present as an acute intrapartum emergency.
Case:
A 26-year-old woman, gravida 3, para 2, presented in the second stage of labor and gave birth to a macerated, stillborn infant weighing 1,340 g. At the time of delivery it was not known that this was a twin pregnancy. Delivery was achieved only after division of a cord around the neck; it turned out to be that of a live, second twin. This infant, weighing 2,530 g, was delivered by rapid breech extraction and made a satisfactory recovery.
Conclusion:
When multiple pregnancy or monoamniotic multiple pregnancy has not been excluded, a nuchal cord might be that of an undiagnosed second twin.
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