Actitud ante el diagnóstico prenatal de las complicaciones del cordón umbilical en gemelos monoamnióticos

Monoamniotic twin pregnancies are rare (1/10,000 pregnancies), but are associated with a high perinatal mortality rate (30-70%). Fetal death usually results from cord entanglement and/or knots, which are the most representative and hazardous complications. Currently, early and accurate ultrasound diagnosis of this type of twinning can be performed. Furthermore, several ultrasound signs have recently been reported that aid recognition of umbilical cord abnormalities and identification of blood flow compromise. Intensive monitoring with nonstress tests and ultrasonographic follow-up combined with improved neonatal care can decrease the mortality rate in monoamniotic pregnancies by 10%. However, the management of these pregnancies remains controversial. We report a case of knotting of the cords, prenatally detected at 31 weeks. The ultrasonographic findings allowed the obstetric management to be reconsidered, with excellent neonatal outcomes.