MEDICAL AMNIOREDUCTION WITH SULINDAC TO REDUCE CORD COMPLICATIONS IN MONOAMNIOTIC TWINS

OBJECTIVE: Cord entanglement is a common complication of monoamniotic twins and it is associated with high perinatal mortality. Apart from p reterm delivery, no treatment has previously been used to reduce the r isks of this complication. We postulated that reducing amniotic fluid volume would stabilize fetal lie and reduce the risk of cord compressi on. STUDY DESIGN: Cord entanglement was documented in three cases of m onoamniotic twins in the midtrimester. Sulindac was administered to th e mother. Amniotic fluid index, fetal urine output, and umbilical arte ry and ductus arteriosus Doppler waveforms were investigated before an d during treatment by use of real-time and pulsed Doppler techniques. RESULTS: Sulindac was associated with a dose-related reduction in amni otic fluid index and fetal urine production without alteration in feta l flow velocity waveforms. Fetal lie stabilized after commencement of treatment. All six twins were delivered with no complications. CONCLUS ION: Medical amnioreduction with sulindac is a new management option i n monoamniotic twins to reduce cord complications.