Figure 1.

We present a case of a 30-year-old G2 P2 with a previous caesarean section, who presented in our unit at 11 weeks gestation for pregnancy confirmation after normal spontaneous conception. A viable monochorionic monoamniotic twin pregnancy was identified, and the common placenta and the cord insertions, very close to one another, were visualized (a, white arrows). The second ultrasound evaluation at 13 weeks did not reveal any structural abnormalities and the risk for aneuploidies was low (Supplementary Materials). Cord entanglement was suspected at this early gestational age, both in gray scale and color Doppler (b,c). Simultaneous registrations of two different heart rates also suggested the cord entanglement (d, represented by white and yellow arrows). The patient was counselled regarding the diagnosis, the possible complications, and the monitoring plan. The follow-up visit was planned for 16 weeks and both Doppler studies and growth were within normal ranges. From 16 weeks onwards, the follow-up scans were booked every second week. Unfortunately, the patient did not attend the 18 weeks scan, but she had a scan at 19 weeks. Sadly, double fetal demise was diagnosed. We acknowledge that this event was unpreventable and that routinely we recommend a scan every second week for reassurance. When fetal death occurs, this is an acute hemodynamic event, therefore previous scans are usually normal.