Is the location of cord entanglement associated with antepartum death in monoamniotic twins?

Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature

“…Four articles reported on whether cord entanglement was searched for systematically and found on ultrasound examination, giving information on 61 monoamniotic pregnancies in total: cord entanglement was detected by ultrasound in 60/61 (98%) pregnancies and missed in 1/61 (2%). Gestational age at diagnosis of cord entanglement ranged from 11 to 30 weeks. When cord entanglement was observed by ultrasound, the overall survival rate was 105/120 (88%).…”

Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta‐analysis

“…The incidence of mortality varied according to gestational-age window. IUD occurred in 4.3% (95% Kristiansen (2015) 18 Prefumo (2015) 19 Anselem (2015) 20 Van Mieghem (2014) 21 Murata (2013) 23 Suzuki (2013) 24 Aurioles-Garibay (2014) 22 Dias (2011) 25 Quinn (2011) 26 Assuncao (2010) 27 Baxi (2010) 28 Hack (2009) 29 Arabin (2009) 30 Heflin (2008) 31 Cordero (2006) CI, 2.8-6.2%) of cases at 24-30 weeks, 1.0% (95% CI, 0.6-1.7%) at 31-32 weeks and in 2.2% (95% CI, 0.9-3.9%) at 33-34 weeks of gestation, while there was no IUD, either single or double, from 35 weeks of gestation, although the sample size was small (Table 3, Figure 3). sIUD and dIUD occurred, respectively, in 2.0% (95% CI, 1.4-2.7%) and 2.9% (95% CI, 1.8-4.2%) of twins at 24-30 weeks, 0.6% (95% CI, 0.2-1.1%) and 0.7% (95% CI, 0.3-1.2%) at 31-32 weeks, and 1.0% (95% CI, 0.4-1.9%) and 1.6% (95% CI, 0.6-3.0%) of cases at 33-34 weeks of gestation.…”

“…The 25 studies included 1068 MCMA pregnancies (2136 twins); information on perinatal mortality according to the gestational age at loss was provided for 814 non-anomalous twin pairs (1628 twins) reaching 24 weeks of gestation, which represent the population analyzed in this systematic review. 16 Glinianaia (2019) 17 Kristiansen (2015) 18 Prefumo (2015) 19 Anselem (2015) 20 Van Mieghem (2014) 21 Aurioles-Garibay (2014) 22 Murata (2013) 23 Suzuki (2013) 24 Dias (2011) 25 Quinn (2011) 26 Assuncao (2010) 27 Baxi (2010) 28 Hack (2009) 29 Arabin (2009) 30 Heflin (2008) 31 Cordero (2006) 32 Pasquini (2006) 33 DeFalco (2006) 34 Heyborne (2005) 35 Ezra (2005) 36 Demaria (2004) 37 Sau (2003) 38 Allen (2001) 39 Sebire (2000) 40 Only first author is given for each study. Study can be awarded maximum of one star for each numbered item within selection and outcome categories.…”

Presence of an Umbilical Artery Notch in Monochorionic/Monoamniotic Twins

“…The high prevalence of cord entanglement has been previously reported, suggesting that it does not necessarily lead to an abnormal perinatal outcome [2, 26, 37–44]. All other placental and umbilical cord findings, such as a true knot, forked placental insertion [45] and the proximity of cord placental insertions to each other, might contribute to the presence of an umbilical artery notch.…”