Rare Twin Pregnancy with Eight Umbilical Cord Knots Successfully Managed at Rainbow Hospital, HRBR Layout, Bangalore

BENGALURU, India, Sept. 16, 2026 /PRNewswire/ -- Rainbow Hospital, HRBR, has successfully managed one of the rare and complex forms of twin pregnancy—Monochorionic Monoamniotic (MCMA) twins—resulting in the safe delivery and recovery of two healthy baby girls.

The case involved a 37-year-old woman with a history of primary infertility, who sought fertility treatment after several years of unsuccessful attempts to conceive. Following a comprehensive fertility evaluation and an individualised treatment plan, she successfully conceived MCMA twins under the care of Dr. Manju B Nair, Clinical Director – Fertility Services.

Monochorionic monoamniotic (MCMA) twin pregnancies are among the rarest and most complex forms of twin gestation, accounting for approximately 1% of all twin pregnancies. They carry a particularly high risk of complications because both fetuses share a single placenta and a single amniotic sac. Reported overall perinatal mortality rates in MCMA pregnancies have historically been as high as 70–80%, although outcomes have improved considerably with advances in antenatal surveillance and neonatal care. Complications can include umbilical cord entanglement, fetal growth restriction and twin-to-twin transfusion syndrome (TTTS).

MCMA pregnancy is a rare form of identical twin pregnancy in which both babies share a single placenta and a single amniotic sac. Such pregnancies carry significant risks, including umbilical cord entanglement, twin-to-twin transfusion syndrome (TTTS), fetal growth restriction, congenital anomalies and sudden fetal compromise.

Recognising the high-risk nature of the pregnancy, antenatal care was provided under Dr. Manjula Deepak, Lead Consultant – Obstetrics & Gynecology, with early involvement of Dr. Kavyashree, Fetal Medicine Specialist. A comprehensive fetal surveillance protocol was initiated, including detailed ultrasound examinations every two weeks from 16 weeks of gestation. The team closely monitored fetal growth, amniotic fluid, Doppler parameters and umbilical cord status.

With meticulous surveillance and coordinated multidisciplinary care, the pregnancy progressed to 32 weeks of gestation, when the mother presented with premature rupture of membranes (PROM). Considering the high-risk nature of the pregnancy, the obstetric team, supported by the anaesthesiology team led by Dr. Marian Kevin Manoj, Consultant Anaesthesiologist, promptly performed an emergency Caesarean section.

During the procedure, the team encountered extensive umbilical cord entanglement with approximately eight knots, highlighting the complexity and potential risks associated with

MCMA pregnancies. Despite this, the team successfully delivered two premature baby girls weighing 1.52 kg and 1.437 kg.

Following delivery, both babies were admitted to the NICU under the care of Dr. Sujith K R and Dr. Prashanth Shetty, Consultants – Pediatrics & Neonatology, and the dedicated NICU team. The twins required specialised neonatal management, including respiratory support, nutritional optimisation, establishment of feeds, infection prevention, growth monitoring and management of acute issues including respiratory distress and cardiac concerns.

With comprehensive neonatal care and continuous monitoring, both babies made steady progress, established full feeds and demonstrated consistent weight gain. They were subsequently discharged home in stable condition.

Today, both girls are healthy, thriving and achieving age-appropriate growth and developmental milestones, bringing immense joy to their family.

Dr. Manjula Deepak, Lead Consultant – Obstetrics & Gynecology, Rainbow Hospital, HRBR, said "Managing a monochorionic monoamniotic twin pregnancy requires constant vigilance, specialised fetal surveillance and timely decision-making because of the significant risk of umbilical cord entanglement and sudden fetal compromise. In this case, meticulous monitoring throughout the pregnancy allowed us to closely assess the babies and respond promptly when the mother developed premature rupture of membranes at 32 weeks. The discovery of extensive cord entanglement, with approximately eight knots, highlighted the complexity of the pregnancy. Through coordinated multidisciplinary care, timely delivery and expert neonatal management, both babies were able to overcome the challenges associated with prematurity and are now growing and developing well. This outcome reflects the importance of specialised expertise, teamwork and compassionate care in managing complex high-risk pregnancies."

The successful outcome was made possible through the coordinated efforts of Dr. Manju B Nair, Clinical Director – Fertility Services; Dr. Manjula Deepak, Lead Consultant – Obstetrics & Gynecology; Dr. Kavyashree, Fetal Medicine Specialist; Dr. Marian Kevin Manoj, Consultant Anaesthesiologist; Dr. Sujith K R and Dr. Prashanth Shetty, Consultants – Pediatrics & Neonatology, along with the operating theatre staff, nursing personnel and NICU team at Rainbow Hospital, HRBR.

The case highlights the importance of specialised fertility care, expert fetal medicine, intensive antenatal surveillance, timely obstetric intervention and advanced neonatal care in achieving favourable outcomes in complex high-risk pregnancies.

About Rainbow Children's Hospital

Rainbow network comprises 24 hospitals and 6 clinics across 9 cities, with a total bed capacity of ~2,435 beds. Our Pediatric services under "Rainbow Children's Hospital" include newborn and pediatric intensive care, pediatric multi-specialty services, pediatric quaternary care (including organ transplantation); whereas our women care services under "Birthright by Rainbow Hospital" offers perinatal care services which includes normal and complex obstetric care, multi-disciplinary foetal care, perinatal genetic and fertility care along with gynecology services.

Rainbow Children's hospital built on strong fundamentals of multidisciplinary approach with a full-time consultant-led clinical service along with 24/7 commitment in a child centric environment. The company follows a hub-and-spoke operating model where the hub hospital provides comprehensive outpatient, inpatient care, with a focus on tertiary and quaternary services and the spokes provide primary, secondary and emergency care in pediatrics and obstetrics, large outpatient services and comprehensive obstetrics, pediatric and level 3 NICU services. This model is successfully operational at Hyderabad and is gaining traction in Bengaluru. The endeavor is to replicate this approach in Chennai and across the National Capital Region. Subsequently Rainbow intends to expand into tier-2 cities of Southern India.

Rainbow embraces a unique doctor engagement model, where doctors work exclusively on a full-time, retainer basis. The doctors work in teams and have 24/7 commitment, which is particularly important for children's emergency, neonatal, pediatric intensive care services and support pediatric retrieval services. The Company also operates the country's largest pediatric DNB training program in private healthcare, offering post graduate residential DNB and fellowship program.

Please visit www.rainbowhospitals.in for more information.