umbilical cord entanglement
Umbilical cord entanglement is a feature which can mean either one or more loops of the cord being encircled around any part of the fetal body or two umbilical cords getting entangled with each other. In the latter situation, it is a classical feature of a monochorionic-monoamniotic twin pregnancy. Very rarely it can occur in a diamniotic twinning with disruption of the dividing membrane either naturally or secondary to a procedure such as an amniocentesis.
Epidemiology
It is often considered a part of normal early fetal development and can be a common finding in the 1 trimester. It has been described in over 70% of MCMA twin pregnancies and it is less of a problem in very early pregnancy.
Radiographic features
Ultrasound
If an associated tightening/knot is a concern Doppler assessment can be carried out.
Doppler assessment
If there is problematic flow due to cord entanglement there may be evidence of abnormal RI's and S:D ratios, the presence of diastolic notching and reduction in end diastolic flow in umbilical arterial Doppler assessment and pulsatile waveforms in umbilical venous flow assessment.
Significance
Cord entanglement itself is rarely a problem but an associated tightening leading to an umbilical cord knot is a concern where arterial compromise can cause catastrophic complications.
Differential diagnosis
Considerations in ultrasound include
- true or false umbilical cord knot in one twin
See also
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu entangled cords: