Cord entanglement in monochorionic monoamniotic twins.

Monochorionic monoamniotic twin gestations have been associated with perinatal mortality rates as high as 28% to 47%. Umbilical cord entanglements and knots, twin-to-twin transfusion syndrome, congenital anomalies, prematurity and intertwin locking during labor are responsible for their high perinatal morbidity and mortality. We report here two cases of cord entanglements: One of them was associated with twin-to-twin transfusion syndrome with gross vascular anastomoses and a massive cord entanglement. The other one was associated with cesarean section due to dystocia of cord entanglement of the second fetus after vaginal birth of the first one. There is still no consensus in literature for the management and the mode of delivery of these rarely encountered cases (Fig. 3, Ref. 13).