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

BACKGROUND: Monoamniotic twinning is frequently complicated by umbilical co rd entanglement and fetal death. Should vaginal delivery take place, this m ay 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. D elivery was achieved only after division of a cord around the neck; it turn ed out to be that of a live, second twin. This infant, weighing 2,530 g, wa s 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 twi n.