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... patient presented with severe dyspnea and premature uter- ine contractions. The authors performed amnioreduction at 27+5 weeks and removed 1.1 L of amniotic fluid. After this procedure the patient's symptoms improved. The NST pattern was reactive and the diastolic flow of the umbilical artery was observed through Doppler sonography in the smaller fetus. At 28+5 weeks, on ultrasonography, the fetuses were of sizes 30+5 and 27+5 weeks gestation and had each AFI of 26 and 7 cm. The smaller twin displayed an absence of diastolic flow of the umbilical ar- tery and the bladder was not visible. Therefore, the authors re- moved 1.8 L of amniotic fluid by secondary amnioreduction. After amnioreduction, both the diastolic flow of the umbilical ar- tery and a small bladder were observed in smaller twin at 29+1 weeks. At 29+3 weeks gestation, a cesarean section was per- formed due to decreased reactivity with deceleration in NST and absent diastolic flow of the umbilical artery in smaller twin. Dis- cordant twin female fetuses with umbilical cord entanglement were delivered (Figure 3). First twin weighed 1,550 grams and had Apgar scores of 4 at one minute and 6 at five minutes. An- Revised manuscript accepted for publication March 26, 2015 ...
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