Notching of the umbilical artery waveform associated with cord entanglement in a monoamniotic twin pregnancy

Abstract

Cord accidents are the principal cause of the high rates of morbidity and mortality associated with monoamniotic twins. Observation of an umbilical artery notch might be a highly specific sign for cord entanglement involving a tight cord knot. It thus justifies the implementation of intense surveillance and should be one of the factors taken into account in deciding on early delivery of the twins.

Presence of an Umbilical Artery Notch in Monochorionic/Monoamniotic Twins

“…In this report, when the umbilical artery notch was observed, there was already one fetal demise, and the surviving twin demonstrated an elevated systolic/diastolic ratio in the umbilical artery, pulsation of the umbilical vein and variable decelerations on the nonstress test. Subsequent studies, such as that from Hugon-Rodin et al [22] and ours, have not found such an association. The presence of an umbilical artery notch in both fetuses was previously reported by Abuhamad et al [36] with a favorable outcome for both twins.…”

“…Table 2 summarizes the findings and obstetrical outcome of previous studies reporting of notching in the umbilical artery waveform in MC/MA twin gestations [20–22]. All were reported in the third trimester and 3 out of 4 had a favorable perinatal outcome.…”

“…One of the twins died in utero and the co-twin had a non-reassuring fetal heart rate pattern requiring an emergency cesarean delivery [20]. Therefore, the presence of an umbilical artery notch in the setting of MC/MA twins has been considered a poor prognosis sign, but has seldom been reported [20–22]. …”

“…The prevalence of cord entanglement can reach 70–80% in all MC/MA pregnancies [26], yet most will have a favorable outcome [27]. In addition, Hugon-Rodin et al [22] and Abuhamad et al [21] have reported favorable outcomes in MC/MA twin gestations when an umbilical artery notch is present; however, further observations are desirable. In this study, we aimed to examine the association between an umbilical artery notch and signs of fetal deterioration in MC/MA twin pregnancies.…”

Monoamniotic monokoryonik ikiz sirkumvallat plasenta ve konglomere umbilikal kord

“…The lack of end-diastolic flow in the umbilical artery doppler tracking of mono-amniotic twins is less informative than in singleton pregnancies 16 . Cordero et al looked 36 MCMA twin pregnancy, and they reported in 15 MCMA twins of these determined cordon entanglement, 3 MCMA twins determined twin-twin transfusion syndrome, 4 newborn revealed IUGR, 6 newborn had a congenital malformation.…”