Endoscopic Ligation of Umbilical Cord at 19 Week’s Gestation in Monoamniotic Monochorionic Twins Discordant for Hypoplastic Left Heart Syndrome

Abstract

We report the first attempt of reduction of monoamniotic twins, discordant for hypoplastic left heart syndrome, using a new fetoscopic technique. Employing sonographic guidance and endoscopic visualization, cord ligation was accomplished, but significant cord entanglement, not previously appreciated, resulted in the ligation of the umbilical cord of the normal fetus. Cord entanglement may frustrate endoscopic techniques in monoamniotic twins.