Endoloop ligation of the umbilical cord of an aborted fetus in a twin gestation

Abstract

A 28-year-old primigravida who had conceived bichorionic twins after undergoing assisted reproductive treatment presented to the emergency department in the 18th week of pregnancy. She was experiencing contractions and mild vaginal bleeding, and the cervix was found to be dilated to 5 cm. The contractions stopped after the spontaneous expulsion of one of the fetuses, approximately 3 hours following admission. The vaginal bleeding stopped, there were no clinical or laboratory signs of chorioamnionitis, and the results of the clotting tests were normal. On ultrasound the other fetus was of appropriate size for gestational age, was surrounded by a normal amount of amniotic fluid, and seemed viable. The prolapsed umbilical cord of the aborted fetus wasexposedusing an aseptic speculum and ligated high in the cervical canal using the Endoloop automated device fitted with a size-0 Endoloop ligature (Endoloop Ligature Type-0 Coated Vicryl; Ethicon, Summerville, NJ, USA). The cervix was then sutured according to the McDonald procedure. Prophylactic antibiotics were administered perioperatively. The patient had no clinical signs of infection or impending placental abruption and was soon discharged.