Twins survive rare pregnancy with eight umbilical cord knots

BENGALURU: Two babies sharing a single amniotic sac, their umbilical cords twisting around each other into nearly eight knots, and yet both continuing to receive enough blood to survive — this was the extraordinary course of a rare twin pregnancy managed at a city hospital. Born prematurely at 32 weeks, the babies are now healthy and meeting age-appropriate developmental milestones.The 37-year-old woman, who had a history of primary infertility, was carrying monochorionic monoamniotic (MCMA) twins — among the rarest and most complex forms of twin pregnancy, accounting for only about 1% of all twin pregnancies. In this condition, the babies share not only the same placenta but also a single amniotic sac, leaving their umbilical cords free to intertwine as they move.According to the treating doctors, cord entanglement is one of the biggest threats in such pregnancies, as it can restrict blood flow to one or both babies. Historically, overall perinatal mortality in MCMA pregnancies has been reported to be as high as 70–80%. However, outcomes have improved with intensive fetal surveillance, timely intervention and advances in neonatal care, the doctors said.Dr Manjula Deepak, lead consultant, obstetrics and gynaecology, Rainbow Hospital, HRBR, said the outcome was particularly significant given her own experience with such pregnancies.

I have had six monochorionic monoamniotic twin pregnancies in my six-year career. All of them ended in abortion or complications. I could not take any of those pregnancies beyond 20 weeks,” she said.

In the present case, she said the pregnancy progressed well under close monitoring, with detailed scans conducted every two weeks from 16 weeks. Doctors closely monitored fetal growth, amniotic fluid levels, Doppler blood-flow parameters and the condition of the umbilical cords.

The babies continued to grow without evidence of intrauterine growth restriction, while blood-flow parameters remained satisfactory.

However, at 32 weeks, the mother developed premature rupture of membranes and began experiencing water discharge. Since both babies were still doing well and there were no signs of fetal distress, the decision to deliver was prompted by the membrane rupture rather than any detected cord-related complication, Dr Manjula said.

During the emergency Caesarean section, doctors found extensive entanglement of the two umbilical cords, with approximately eight knots. The entanglement had not been detected on the scans. Despite the extent of the knotting, blood flow to both babies had continued, allowing them to grow normally. Both were delivered alive and crying, without signs of distress.

Even two cords intertwining can be enough to stop the blood flow.

But in spite of that, the blood flow remained to the babies and they continued to grow,” Dr Manjula said.

The premature girls weighed 1.5 kg and 1.437 kg at birth and spent time in the NICU, where they received respiratory and nutritional support and were closely monitored for complications related to prematurity. Doctors said the babies subsequently established full feeds, gained weight and were discharged in stable condition.

Dr Manjula attributed the favourable outcome to the mother’s confidence and cooperation, regular fetal surveillance and coordinated multidisciplinary care.