Vaginal delivery of monoamniotic twins with umbilical cord entanglement. A case report.

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.