Complex Twisted Knots of Umbilical Cord in a Monochorionic-Diamniotic Twin Gestation: A Case Report
DOI:
https://doi.org/10.31661/gmj.v9i.1878Keywords:
Umbilical cord Entanglement; Nuchal Cord; Multiple Entanglement, Twin PregnancyAbstract
Background: True knots and tight loops of umbilical cord can cause serious fetal complications in monochorionic-monoamniotic twins but are usually unexpected in Monochorionic-diamniotic twins because of the presence of the intertwin membrane. This report presents a case of monochorionic-diamniotic twin gestation with a complex cord knots. Case report: A 31-year-old G2Ab1 with monochorionic-diamniotic twin pregnancy in the gestational age of 30 weeks presented with ruptured membrane since 3weeks before delivery. At the delivery time, multiple umbilical cord knots was found. Conclusion: Premature ruptured membrane can cause septostomy of the intertwin membrane, multiple umbilical cord knots and its complications. Therefore, these cases should be considered for evaluation of the presence of intertwin membrane and umbilical cord knots in each sonography examination. [GMJ.2020;9:e1878]
References
Chmait RH, Aghajanian P, Kontopoulos EV, Quintero RA. Prenatal diagnosis of spontaneous septostomy of the dividing membranes in complicated monochorionic diamniotic multiple gestations. J Ultrasound Med. 2009 May;28(5):663-8. https://doi.org/10.7863/jum.2009.28.5.663 Clerici G, Koutras I, Luzietti R, Di Renzo GC. Multiple true umbilical knots: a silent risk for intrauterine growth restriction with anomalous hemodynamic pattern. FETAL DIAGN THER. 2007;22(6):440-3. https://doi.org/10.1159/000106351 Fuchs KM, D'Alton ME. Chorionicity of Multiple Gestations. InObstetric Imaging. FETAL DIAGN THER. Fetal Diagnosis and Care 2018 Jan 1 (pp. 639-641). Elsevier. https://doi.org/10.1016/B978-0-323-44548-1.00158-3 Szczepanik ME, Wittich AC. True knot of the umbilical cord: a report of 13 cases. Mil med. 2007 Aug 1;172(8):892-4. https://doi.org/10.7205/MILMED.172.8.892 Lee KJ, Kim MK, Lee SY, Lee WS, Lee YH. Spontaneous rupture of the dividing membrane in a monochorionic pregnancy resulting in a pseudo-monoamniotic pregnancy with cord entanglement. J OBSTET GYNAECOL RE. 2012 May;38(5):863-6. https://doi.org/10.1111/j.1447-0756.2011.01795.x Suzuki S. Case series of monoamniotic and pseudomonoamniotic twin gestations.OBSTET GYNECOL.2013 Feb 21;2013. https://doi.org/10.1155/2013/369419 Sherer DM, Sokolovski M, Haratz-Rubinstein N. Diagnosis of umbilical cord entanglement of monoamniotic twins by first-trimester color Doppler imaging. J of ultrasound med: official journal of the American Institute of Ultrasound in Medicine. 2002 Nov;21(11):1307-9. https://doi.org/10.7863/jum.2002.21.11.1307 Suzuki K, Itoh H, Kimura S, Sugihara K, Yaguchi C, Kobayashi Y, Hirai K, Takeuchi K, Sugimura M, Kanayama N. Chorangiosis and placental oxygenation. Congenit anom. 2009 Jun;49(2):71-6. https://doi.org/10.1111/j.1741-4520.2009.00226.x
