Cord Entanglement in Monochorionic Diamniotic Twin Pregnancy: A Rare Diagnostic and Clinical Challenge

Umbilical cord entanglement is a well-known complication in monochorionic monoamniotic twin pregnancies but is extremely rare in monochorionic diamniotic (MCDA) pregnancies due to the presence of an intertwin membrane. We report a case of a 24-year-old G4P1-0-2-1 at 33 weeks and two days of gestation presenting with intrauterine fetal demise of both twins in an MCDA pregnancy. Clinical evaluation and ultrasonography confirmed the demise, and postpartum examination revealed cord entanglement with true knots despite an intact intertwin membrane. This case highlights the importance of vigilant sonographic surveillance of the intertwin membrane and umbilical cords in high-risk MCDA pregnancies to prevent adverse outcomes.