Early prenatal diagnosis of cord entanglement in monoamniotic multiple pregnancies

Abstract

Diagnosis of cord entanglement is feasible early in gestation. Future protocols are proposed to document the gestational age at detection, the location, and the Doppler flow patterns and to facilitate the assessment of short- and long-term development.

Perinatal Mortality in Multiple Pregnancy

“…Umbilical cord entanglement may be detected with prenatal ultrasound and color Doppler. The initiation of cord entanglement can occur as early as first trimester, when the amniotic fluid volume in relation to the fetal mass is greater (Arabin et al 1999). In the literature, many strategies have been proposed including admission to hospital -after viability has been established -with cardiotocography several times a day and the use of pharmacological agents to reduce amniotic fluid volume in the hope of preventing fetal loss from cord accidents.…”

Pautas De Manejo Clínico De Embarazos Gemelares

“…El entrecruzamiento de los cordones es patognomónico de gemelos monoamnióticos y es evaluable desde el primer trimestre con el uso de Doppler pulsado en el ovillo de vasos, demostrando la presencia de 2 frecuencias cardiacas distintas (64). Otras características ultrasonográficas que apoyan el diagnóstico son: a) ausencia de membrana amniótica divisoria b) presencia de placenta única c) ambos fetos del mismo sexo d) cantidad adecuada de líquido amniótico alrededor de cada feto e) ambos fetos se mueven libremente dentro de la cavidad uterina Los gemelos monoamnióticos tienen una alta tasa de mortalidad (hasta un 50%) que se atribuye al entrecruzamiento de cordones, nudos de cordón, anomalías congénitas y prematurez.…”

Is the location of cord entanglement associated with antepartum death in monoamniotic twins?

“…In 1999 we published a series of three cases with monoamniotic placentation and early diagnosis of cord entanglement in this journal, in which we differentiated between cord entanglement close to the umbilical insertions interposed between the ventral surface of the two fetuses and entanglement close to the chorionic plate 3 . Meanwhile, we have collected and documented 18 monoamniotic twin pregnancies in which the diagnosis and location of cord entanglement were recorded in the first trimester.…”

“…The majority of cases occur in young women, with exceptional cases reported in postmenopausal women and in men 2,3 . Genetic causes have also been suggested 7 .…”