Amniorupture Leading to Cord Entanglement in Twin Gestation Complicated by Twin to Twin Transfusion

Twin to twin transfusion syndrome (TTTS) is a common complication of monochorionic twin gestations. If untreated, this condition carries a very high mortality rate for both twins. The therapeutic options available today are still rather limited. Therapeutic amniocentesis (amnioreduction) of the recipient twin's amniotic fluid has been shown to be effective in equalising pressures between the two amniotic cavities1,decreasing the incidence of hydrops in the recipient, and subsequently improving perinatal outcome. 2,3,4 It is worth noting that during amnioreduction, a small percentage of monochorionic diamniotic pregnancies may be iatrogenically converted to monoamniotic pregnancies (also described as pseudomonoamniotic) carrying with it the high risk of cord entanglement as well as subsequent risk of morbidity and mortality which is observed in true monoamniotic pregnancies.5 This presentation describes the occurrence of amniorupture in a twin pregnancy affected by TTTS and highlights the potential complications.