A pregnant woman without fetal heartsounds

A 31-year-old woman reported to a Malawian district hospital. She was pregnant of twins and in labour, and had received no prenatal care. There were no fetal heartsounds on examination. The patient spontaneously delivered 2 macerated stillbirths. A monochorionic placenta in 1 amniotic sack was seen with 2 entangled umbilical cords, a feared complication in monoamniotic monochorionic twin pregnancy.