Monoamniotic twins

Green, Quentin L.; Jackson, James; Miller, Alexandre

doi:10.1016/0002-9378(60)90515-9

Cited by 11 publications

(2 citation statements)

References 6 publications

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“…The particular danger which arose in this casenamely, that if the cord not known to be that of the second twin is cut because it impedes the delivery of the first twin then the second baby is in jeopardy unless promptly delivered-has been mentioned as a hazard of monoamniotic twins by several recent authors-for example, Green et al (1960) and Raphael (1961).…”

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“…And as an increasing incidence has been reported, so in an increasing proportion of cases have both babies survived-from the 16% quoted by Quigley (1935) to the 46% calculated by Raphael (1961) for cases reported since 1935. The foetal loss is largely due to interference with the foetal circulation by twisting and knotting of the umbilical cords.The particular danger which arose in this casenamely, that if the cord not known to be that of the second twin is cut because it impedes the delivery of the first twin then the second baby is in jeopardy unless promptly delivered-has been mentioned as a hazard of monoamniotic twins by several recent authors-for example, Green et al (1960) and Raphael (1961).Moral.-There is an increasing tendency for immediate delivery of the second twin after the first in all cases; in monoamniotic twins it is essential for good foetal results. Whenever after delivery of the first twin no second bag of membranes is found, or its cord is seen to be knotted or twisted, or the " wrong " cord is seen to have been cut, the second baby must be delivered at once.…”

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A Rare Complication of Twin Delivery

Bender¹,

Prebble²

1961

BMJ

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MEDICAL MEMORANDA in the right iliac fossa for the preceding 24 hours, but this passed off after defaecation before the boy arrived at the hospital. He admitted to twinges of similar but less severe pain at times in the past. There was no fever, the right side of the scrotum was empty, and the testis was not palpable in the inguinal canal. He returned on November 17 with recurrence of the symptoms, especially on lying down, and tenderness to pressure in the right iliac fossa.On examination no real tenderness was demonstrable and the patient was afebrile. He attended again the same evening because of an aching pain in the right groin. There was marked tenderness over the right inguinal canal, and there was a slight swelling of the right groin compared with the left. There was also a small lump presenting at the internal ring, with a definite cough impulse. His temperature was 990 F. (37.2°C.) and pulse 104 a minute. Subacute torsion of an undescended testis was diagnosed.At operation a small congenital hernial sac with a wide neck was disclosed, with the right testis emerging into the inguinal canal through the internal ring. The right testis was three-quarters the size of the left but otherwise apparently normal. Arising from the caput of the epididymis was a small pedunculated gangrenous appendage wrapped in omentum. The appendage was excised and orchiopexy performed. Macroscopically the appendage was a dull, plum-coloured ovoid mass, 7 mm. long by 4 mm. wide, which from the site of attachment of its pedicle appeared to be an appendix epididymis. Microscopical examination showed: " A tubular columnar epithelium, rather like that of epididymis but spoiled by autolysis. The outer covering is completely missing, probably for the same reason. It does not resemble the available specimens of torsion of the hydatid of Morgagni, none of which has internal tubules."Comment.-This case demonstrates the confusion which can occur in diagnosing this condition. Whether the cause of the torsion was the obvious attempt of the testis at descent is a matter for speculation. There seems to be no previous record of torsion of the appendix epididymis associated with maldescent of the testis.I am indebted to Mr. R. Parkinson and Mr. J. T. Fathi for their permission to publish these cases, and to the latter for encouraging me to do so. I would like to thank Dr. J. W. A Rare Complication of Twin Delivery CASE HISTORY A woman of 47 who had previously had eight full-time pregnancies and one abortion was found to have a twin pregnancy. At the 32nd week she was admitted to hospital for a period of rest as a precaution against very premature labour (Bender, 1952), remaining for over two weeks without untoward signs or symptoms. At the 36th week she developed marked oedema of the legs but no hypertension or albuminuria, and she was readmitted.At 4.15 a.m. on February 22, 1961, 27 days before her expected date of confinement, there was spontaneous rupture of the membranes and strong contractions followed immediately. The first twin was presen...

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confidence: 92%

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confidence: 95%