| Early prenatal diagnosis of cord entanglement in monoamniotic multiple pregnancies. | |
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MedLine Citation:
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PMID: 10204209 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Cord entanglement is a severe complication in monoamniotic multiple pregnancies. Three cases were reviewed to determine how early ultrasound diagnosis might improve counselling and management. METHODS: In two monoamniotic twin and one dichorionic diamniotic triplet pregnancies, cord entanglement was detected between 10 and 18 gestational weeks by color Doppler and pulsed Doppler velocimetry. Pregnancies were followed up on a weekly basis with special observation of fetal behavior and use of color Doppler velocimetry. RESULTS: In Case 1, a monoamniotic twin pregnancy with cord entanglement close to the umbilical insertions was diagnosed at 10 weeks. Longitudinal follow-up showed intrauterine death of both twins at 15 weeks. In Case 2, entanglement of the umbilical cords of two monoamniotic triplets within a dichorionic diamniotic triplet pregnancy was diagnosed at 10 weeks. The pregnancy continued uneventfully until 35 weeks when cord entanglement was confirmed at Cesarean section. All triplets have since developed normally. In Case 3, monoamniotic twins were diagnosed at 18 weeks. Color Doppler detected side-by-side insertion of the umbilical cords and Doppler velocimetry suggested an entanglement at the chorionic plate. The pregnancy was complicated by polyhydramnios. Cesarean section at 36 weeks confirmed cord entanglement at the chorionic plate. Postnatal computer angiography and morphological examination of the placenta showed the presence of superficial artery-to-artery and vein-to-vein anastomoses and of deep arteriovenous shunts. The development of the twins was uneventful. CONCLUSIONS: Diagnosis of cord entanglement is feasible early in gestation. Future protocols are proposed to document the gestational age at detection, the location, and the Doppler flow patterns and to facilitate the assessment of short- and long-term development. |
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Authors:
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B Arabin; R N Laurini; J van Eyck |
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Publication Detail:
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Type: Case Reports; Comment; Journal Article; Review |
Journal Detail:
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Title: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Volume: 13 ISSN: 0960-7692 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 1999 Mar |
Date Detail:
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Created Date: 1999-05-28 Completed Date: 1999-05-28 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 9108340 Medline TA: Ultrasound Obstet Gynecol Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 181-6 Citation Subset: IM |
Affiliation:
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Department of Perinatology, Isala Hospital, Zwolle, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Amnion / ultrasonography Angiography Arteriovenous Fistula / radiography Cesarean Section Chorion / ultrasonography Female Fetal Death / ultrasonography Fetal Diseases / ultrasonography* Follow-Up Studies Gestational Age Humans Placenta / blood supply, radiography Pregnancy Pregnancy, Multiple* Rheology Triplets* Twins* Ultrasonography, Doppler, Color Ultrasonography, Doppler, Pulsed Ultrasonography, Prenatal* Umbilical Arteries / radiography Umbilical Cord / ultrasonography* Umbilical Veins / radiography |
| Comments/Corrections | |
Comment On:
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Ultrasound Obstet Gynecol. 1999 Mar;13(3):157-60
[PMID:
10204204
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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