# Severe Cord Entanglement in a Monochorionic–Monoamniotic Twin Pregnancy: Highlighting Perinatal Risks and Management Challenges—A Case Report

## TL;DR

A rare case of monochorionic–monoamniotic twin pregnancy with severe cord entanglement is reported, highlighting careful management leading to positive outcomes.

## Contribution

This case report highlights the successful management of an extreme umbilical cord entanglement in a high-risk twin pregnancy.

## Key findings

- A 27-year-old woman had a favorable outcome despite 17 loops of umbilical cord entanglement in an MCMA twin pregnancy.
- Early diagnosis and timely delivery at 32 weeks resulted in positive neonatal outcomes for both infants.
- The case emphasizes the importance of multidisciplinary care in managing high-risk MCMA pregnancies.

## Abstract

Monochorionic–monoamniotic (MCMA) twin pregnancies represent the rarest and highest risk form of twin gestation, largely due to complications such as umbilical cord entanglement (UCE). We report a case of a 27‐year‐old woman with a spontaneously conceived MCMA twin pregnancy complicated by an extreme intraoperative finding of 17 loops of UCE, yet with a favorable neonatal outcome. MCMA gestation was diagnosed antenatally by ultrasound demonstrating a single placenta without an intertwin membrane. The patient was admitted at 31 weeks′ gestation for planned inpatient monitoring and administration of antenatal corticosteroids, followed by elective cesarean delivery at 32 weeks′ gestation. Both female neonates were delivered in vertex presentation and admitted to the neonatal intensive care unit (NICU) due to prematurity. Birthweights, Apgar scores, and short‐term neonatal outcomes were reassuring, with no major complications noted prior to discharge. This case underscores the importance of early diagnosis, close fetal surveillance, and appropriately timed delivery in MCMA pregnancies. Despite the high risk associated with UCE, favorable outcomes can be achieved through vigilant prenatal care and multidisciplinary management.