Medical amnioreduction with sulindac to reduce cord complications in monoamniotic twins.
OBJECTIVE
Cord entanglement is a common complication of monoamniotic twins and it is associated with high perinatal mortality. Apart from preterm delivery, no treatment has previously been used to reduce the risks of this complication. We postulated that reducing amniotic fluid volume would stabilize fetal lie and reduce the risk of cord compression.


METHODS
Cord entanglement was documented in three cases of monoamniotic twins in the midtrimester. Sulindac was administered to the mother. Amniotic fluid index, fetal urine output, and umbilical artery and ductus arteriosus Doppler waveforms were investigated before and during treatment by use of real-time and pulsed Doppler techniques.


RESULTS
Sulindac was associated with a dose-related reduction in amniotic fluid index and fetal urine production without alteration in fetal flow velocity waveforms. Fetal lie stabilized after commencement of treatment. All six twins were delivered with no complications.


CONCLUSIONS
Medical amnioreduction with sulindac is a new management option in monoamniotic twins to reduce cord complications.
Peek
M J
MJ
Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, Queen Charlotte's and Chelsea Hospital, London, United Kingdom.
McCarthy
A
A
Kyle
P
P
Sepulveda
W
W
Fisk
N M
NM
D000653:Amniotic Fluid / Q000187:drug effects* / Q000502:physiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007746:Labor Presentation; D010920:Placenta; D011247:Pregnancy; D013467:Sulindac / Q000627:therapeutic use*; D014430:Twins, Monozygotic; D014556:Urine / Q000502:physiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D013467:Sulindac