Can Cord Entanglement Occur in Monochorionic Diamniotic Twins? A Rare Case of Spontaneous Septostomy of Dividing Membranes
Abstract
Background: Twin pregnancies are known to be complicated, with monochorionic monoamniotic (MCMA) pregnancies holding more risks compared to dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) pregnancies. Cord entanglement is a common complication in the context of MCMA twins, however can this occur in MCDA twins?
Case: A 26-year-old woman was referred to a high-risk tertiary unit at 18 weeks gestation, where scan confirmed MCDA pregnancy. She was regularly followed up in clinic. After presenting at 29 weeks with preterm labor that was managed at the time; she later presented at 31 weeks, distressed with labor pains. Repeated scans showed unexpected severe intrauterine growth restriction of both babies. During her Cesarean section at 32 weeks, clinicians noted both umbilical cords were tightly tangled, which uniquely occurs with MCMA rather than MCDA. Upon reviewing the literature for similar cases, an extremely rare phenomenon called spontaneous septostomy of dividing membranes (SSDM) had occurred. This led to an MCDA twin pregnancy functionally becoming MCMA with its high risks of cord entanglement and fetal demise.
Discussion: The incidence of SSDM is truly unknown due to the rarity of the condition, but it is associated with increased morbidity and mortality. Limited literature states that possible causes of this are abdominal trauma during pregnancy, iatrogenic procedures, and chorioamnionitis. Despite the great mortality rate of this complication, both…
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