A monoamniotic-monochorionic twin pregnancy is a condition where twins are developing inside the same amniotic sac. This is an extraordinarily unusual dangerous pregnancy, as it can lead the umbilical cords of the two babies to become intertwined. In case this happens the two babies might die or one of the twins could die and the other suffer a significant brain injury. In situations in which umbilical cord occlusion happens, time is critical for the doctor to diagnose the problem and do an emergency C-section.

In a certain number of pregnancies concerning twins a condition can come up in which both twins grow within a single amniotic sac. This predicament is known as a monoamniotic-monochorionic pregnancy. There is the possibility that the umbilical cords can become entangled endangering the health and even the live of the babies. In some cases where there is umbilical cord occlusion the two twins die. In other scenarios one baby lives but sustains permanent brain damage. Doctors normally concur that these pregnancies should be carefully monitored. By doing this, in the event that an umbilical cord problem occurs a timely emergency C-section can save the twins.

In the unusual situation in which unborn twins share the same amniotic sac there is a considerable risk that their umbilical cords will end up entangled. This restricts the oxygen supply to the twins. In some cases both babies die. In some other situations even though one baby survives that twin is left with a severe brain injury. An emergency C-section as soon as an umbilical cord occlusion arises is the only way to save both babies and prevent a brain injury. This requires careful checking of the mother for the duration of the pregnancy for signs that the umbilical cords are entangled.

One form of high risk pregnancy happens if the woman is carrying twins but only one amniotic sac, a condition referred to as monoamniotic-monochorionic twins. This class of pregnancy is correlated with the risk of umbilical cord entanglement. When this occurs the oxygen supply to the twins may become restricted. The babies need a steady supply of oxygen to develop normally. Being subjected to a prolonged length of time under oxygen insufficiency may lead to brain damage or possibly the death of the twins. Considering that this is a known complication of a monoamniotic-monochorionic twin pregnancy the pregnant woman's doctor ought to properly monitor the pregnancy for any signs of umbilical cord occlusion. Doctors typically acknowledge that to be able to protect the life and health of the babies the medically correct course of action is an emergency C-section as soon as clues of this complication arise.

Below we explore a published case in which the pregnant woman was diagnosed with this type of pregnancy. Beginning in the 26th week of the pregnancy her doctor prescribed twice a week non-stress testing to keep tabs on vital signs of her twins. Although it was standard practice to admit the mother and have the twins monitored every day, the doctor did not do this and sometime between two tests, one twin passed away and the other twin suffered severe brain damage.

The parents filed a case alleging medical malpractice. Even though the mother and father had suffered a tragic loss, the defense did not settle. The law firm that helped the family took the lawsuit to trial. After overcoming a number of procedural hurdles and an appeal by the defense, the Appeals Court upheld the jury award to the family in the amount of $3,000,000. The Appeals Court even cited a number of studies and articles which stated that to ensure the safety of both twins it is necessary to admit the pregnant woman at approximately the twenty sixth week of her pregnancy and to perform non-stress tests at least daily, if not 2 or 3 times daily, to follow the vital signs of the twins.