Emergency double McDonald cerclage in twin gestation with single fetal death and simultaneous prolapse of both amniotic sacs

A woman in her mid-30s at 24+5 weeks of a dichorionic diamniotic twin pregnancy with single intrauterine fetal demise presented with simultaneous prolapse of both amniotic sacs into the vagina and a 3 cm dilated cervix. She underwent ultrasound-guided amnioreduction and an emergency double McDonald cerclage using two Ethibond #2 sutures placed 1 cm apart. The pregnancy was successfully prolonged to 36+5 weeks, resulting in caesarean delivery of a healthy neonate weighing 2220 g and the demised co-twin. This case is unique, as it provides the first documented clinical and ultrasound images of simultaneous prolapse of both sacs in a twin pregnancy successfully managed by double cerclage.