title: [Transcervical Embryoscopy after Missed Abortion in Monoamniotic Twins with Discordant Exencephaly].
abstract: BACKGROUND
  Monoamniotic twins are considered a cause of high-risk pregnancies. Thereby, discordant malformations do occur rarely. A discordant exencephaly has been described in only a few cases. Transcervical embryoscopy can be performed in cases of monoamniotic twins with missed abortion directly before the abort-curettage.
  
  
  METHODS
  The case of a 35-year-old G1/P0 women in the 12(th) week of pregnancy is described. She had a monoamniotic twin pregnancy with discordant exencephaly and missed abortion diagnosed at 11+2 weeks. A transcervical embryoscopy was performed immediately before the abort-curettage and identified the discordant exencephaly and an additional umbilical cord knot of the 2 foetuses as a probable cause for the abortion.
  
  
  CONCLUSIONS
  The transcervical embryoscopy lead in our case report to the diagnosis of a umbilical cord knot in a monoamniotic twin pregnancy with missed abortion. We also identified a discordant exencephaly by embryoscopy. With blunt access to the amniotic cavity, the transcervical embryoscopy applies only a minor additional risk to the abort-curettage. However, it should only be performed when the patient explicitly asks for enhanced diagnostics.
  
  
  CONCLUSIONS
  Transcervical embryoscopy can be performed as an additional diagnostic tool in cases of monoamniotic twins with missed abortion. However, a detailed risk-benefit analysis should be done upfront in consultation with the patient.
authors.affiliation: KU Leuven, Department of Development and Regeneration, Leuven, Belgien.
authors.forename: A C
authors.initials: AC
authors.lastname: Engels
authors.affiliation: Diakonie Neuendettelsau, Klinik Hallerwiese, Abteilung für Gynäkologie und onkologische Gynäkologie, Nürnberg.
authors.forename: S
authors.initials: S
authors.lastname: Haide
authors.affiliation: Diakonie Neuendettelsau, Klinik Hallerwiese, Abteilung für Gynäkologie und onkologische Gynäkologie, Nürnberg.
authors.forename: K
authors.initials: K
authors.lastname: Schanz
authors.affiliation: Diakonie Neuendettelsau, Klinik Hallerwiese, Abteilung für Geburtshilfe und Pränatalmedizin, Nürnberg.
authors.forename: J
authors.initials: J
authors.lastname: Knabl
authors.affiliation: Diakonie Neuendettelsau, Klinik Hallerwiese, Abteilung für Gynäkologie und onkologische Gynäkologie, Nürnberg.
authors.forename: F
authors.initials: F
authors.lastname: Bartzsch
authors.affiliation: Diakonie Neuendettelsau, Klinik Hallerwiese, Abteilung für Geburtshilfe und Pränatalmedizin, Nürnberg.
authors.forename: F
authors.initials: F
authors.lastname: Kainer
mesh_terms: D000030:Abortion, Missed / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009436:Neural Tube Defects / Q000196:embryology / Q000601:surgery*; D011247:Pregnancy; D016896:Treatment Outcome; D014427:Twins