Korean J Obstet Gynecol.  2011 Jun;54(6):304-307. 10.5468/KJOG.2011.54.6.304.

Antepartum spontaneous rupture of the intertwin-dividing membrane in monochorionic diamniotic twins; Nearly adhered cords

• Oh JE
• Bae JY
• Hwang IA
• Kim MJ
• Seong WJ

• KMID: 2274039
• DOI: http://doi.org/10.5468/KJOG.2011.54.6.304

Abstract

Umbilical cord entanglement has been reported to occur in monoamniotic twins. However, it can occur in diamnionic twins due to rupture of the intertwin-dividing membrane, and is a cause for concern. A 31-year-old nullipara visited our hospital at 28+3 weeks gestation. A monochorionic diamniotic twin gestation was diagnosed ultrasonographically by visualizing a thin intertwin-dividing membrane and a single placenta. A cesarean section was performed at 35+3 weeks gestation and concordant twin fetuses with entangled umbilical cords were delivered. Gross examination revealed a single placenta with a ruptured dividing membrane. Our case, along with the other cases, confirms that antepartum rupture of an intertwin-dividing membrane is a clinical condition that should be considered in all cases of monochorionic diamniotic twin. A careful inspection of the dividing membrane and each cord insertion site should be performed. Once the dividing membrane cannot be easily visualized, the possibility of antepartum rupture should be suspected.

Keyword

Amniotic membrane; Rupture; Spontaneous; Twins; Fetal cord entanglement

MeSH Terms

Adult
Amnion
Cesarean Section
Female
Fetus
Humans
Membranes
Nuchal Cord
Placenta
Pregnancy
Rupture
Rupture, Spontaneous
Twins
Umbilical Cord

Figure

• 

  Fig. 1 This image shows the umbilical cords from both twins, and the cords were entangled at multiple sites.

• 

  Fig. 2 After separating the entangled cords, this image shows the two cords are nearly adhered across the two layers of amniotic membrane.

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