Overview
Rainbow Hospital, HRBR, Bengaluru announced on September 16, 2026 the successful management of a rare monochorionic monoamniotic (MCMA) twin pregnancy, culminating in the safe delivery of two healthy baby girls despite the presence of approximately eight umbilical cord knots.
Patient Background and Fertility Treatment
The mother, a 37‑year‑old woman with a history of primary infertility, underwent a comprehensive fertility evaluation and an individualized treatment plan under the supervision of Dr. Manju B Nair, Clinical Director – Fertility Services. The treatment resulted in conception of MCMA twins, a condition that represents roughly 1 % of all twin pregnancies and historically carries perinatal mortality rates of 70–80 %.
Clinical Management of MCMA Pregnancy
Recognising the high‑risk nature of MCMA gestation, antenatal care was coordinated by Dr. Manjula Deepak, Lead Consultant – Obstetrics & Gynecology, with early involvement of Dr. Kavyashree, Fetal Medicine Specialist. A rigorous fetal surveillance protocol was instituted, comprising detailed ultrasound examinations every two weeks beginning at 16 weeks of gestation. The team monitored fetal growth, amniotic fluid volume, Doppler parameters, and umbilical cord status.
At 32 weeks, the mother experienced premature rupture of membranes (PROM). The obstetric team, supported by the anaesthesiology team led by Dr. Marian Kevin Manoj, performed an emergency Caesarean section. Intra‑operatively, extensive umbilical cord entanglement with approximately eight knots was observed, underscoring the complexity of MCMA pregnancies.
Neonatal Outcomes
The twins were delivered prematurely, weighing 1.52 kg and 1.437 kg respectively. Both infants were admitted to the Neonatal Intensive Care Unit (NICU) under the care of Dr. Sujith K R and Dr. Prashanth Shetty, Consultants – Pediatrics & Neonatology. Neonatal management included respiratory support, nutritional optimisation, infection prevention, growth monitoring, and treatment of acute respiratory distress and cardiac concerns. The infants achieved full feeds, demonstrated consistent weight gain, and were discharged home in stable condition. They continue to thrive, meeting age‑appropriate growth and developmental milestones.
Institutional Context and Expansion Plans
Rainbow’s network comprises 24 hospitals and 6 clinics across nine cities, offering a total bed capacity of approximately 2,435 beds. Pediatric services are delivered under the “Rainbow Children’s Hospital” brand, encompassing newborn and pediatric intensive care, multi‑specialty services, and quaternary care such as organ transplantation. Women’s care services operate under the “Birthright by Rainbow Hospital” brand, providing normal and complex obstetric care, multidisciplinary fetal care, perinatal genetics, and fertility services.
The organization follows a hub‑and‑spoke operating model, with hub hospitals delivering comprehensive tertiary and quaternary services and spoke facilities providing primary, secondary, and emergency care. This model is operational in Hyderabad and Bengaluru, with plans to replicate it in Chennai and the National Capital Region, and to expand into tier‑2 cities of Southern India.
Rainbow employs a unique doctor‑engagement model wherein physicians work full‑time on a retainer basis, ensuring 24/7 availability for emergency, neonatal, and pediatric intensive care. The company also runs the country’s largest private‑sector pediatric DNB training program, offering residential postgraduate and fellowship opportunities.
Statement from Lead Consultant
Dr. Manjula Deepak emphasized that “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.”