High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation

Pasquini, Lucia; Wimalasundera, R.; Fichera, A.; Barigye, O; Chappell, Lucy C; Fisk, Nicholas M.

doi:10.1002/uog.3811

Cited by 63 publications

(83 citation statements)

References 38 publications

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“…The perinatal mortality rates were very comparable among the three studies, as shown in Table 3. The crude perinatal mortality is around 15% for women with monoamniotic twins at ≥22 weeks of gestation, although several small studies have reported better outcomes (Baxi & Walsh, 2010;Cordero et al 2006;DeFalco et al, 2006;Dias et al, 2010;Pasquini et al, 2006;Rodis et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

“…However, monoamniotic twins were likely to exhibit fetal distress or non-reassuring fetal surveillance: 36 (45.6%) of 79 women and 10 (43.5%) of 23 women underwent a prompt delivery because of fetal distress or non-reassuring fetal surveillance in two reports (DeFalco et al, 2006;Heyborne et al, 2005). Therefore, although not yet verified, many investigators consider that inpatient management and the intensive monitoring of monoamniotic twins and early delivery at 32 to 34 weeks of gestation may improve outcome (Allen et al, 2001;DeFalco et al, 2006;Dias et al, 2010;Heyborne et al, 2005;Lewi, 2010;Pasquini et al, 2006;Rodis et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

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Prospective Risk of Intrauterine Fetal Death in Monoamniotic Twin Pregnancies

Morikawa

Yamada

et al. 2012

Twin Res Hum Genet

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This study was conducted to review the overall short-term outcome of monoamniotic twins in Japan and to determine the prospective risk of fetal death so as to adequately counsel parents with monoamniotic twins. Study subjects were 101 women with monoamniotic twins who were registered with the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System and who had given birth at ≥22 weeks of gestation during [2002][2003][2004][2005][2006][2007][2008][2009]. The gestational week at delivery (mean ± SD) was 31.8 ± 3.7. Fourteen women experienced intrauterine fetal death (IUFD). Short-term outcomes of co-twins born to the 14 women included 8 IUFDs, one early neonatal death within 7 days of life (END), and 5 survivors. Four other women experienced 5 ENDs. Thus, 13.9% (28/202) of infants died perinatally (22 IUFDs and 6 ENDs), 13.9% (14/101) of women experienced IUFD, and 82.2% (83/101) of women experienced neither IUFD nor END. Structural anomalies and twin-to-twin transfusion syndrome explained 17.9% (five infants) and 10.7% (three infants) of the 28 perinatal deaths, respectively. The prospective risk of IUFD was 13.9% (14/101) for women who reached gestational week 22 −0/7 , gradually decreasing thereafter but remaining at between 4.5% and 8.0% between gestational week 30 −0/7 and 36 −0/7 .

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prospective Risk of Intrauterine Fetal Death in Monoamniotic Twin Pregnancies

Morikawa

Yamada

et al. 2012

Twin Res Hum Genet

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“…The high loss rate in MCMA twins was initially thought to be mainly due to cord entanglement and subsequent strangulation. However, cord entanglement can be seen in the majority of MCMA twins on prenatal ultrasound (Dias et al, 2010b;Hamilton and Byrd 2009;Pasquini et al, 2006;Rodis et al 1997). It is therefore probable that the cord entanglement in MCMA twins with pregnancy loss is due to a reporting bias.…”

Section: Discussionmentioning

confidence: 99%

“…E-mail: abhide@sgul.ac.uk monoamniotic pregnancies, with perinatal mortality rates ranging from 10 to 13% of non-anomalous fetuses (Allen et al, 2001;Heyborne et al, 2005). This lower perinatal loss rate was attributed to better pregnancy management and elective early delivery by Caesarean section (Pasquini et al, 2006). The present study aims to compare magnitude of risk and timing of fetal loss in MCMA versus MCDA twin pregnancies.…”

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confidence: 99%

Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

et al. 2011

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Objective: To compare the fetal loss rate of monochorionic (MC) twin pregnancies according to their amnionicity. Methods: A retrospective review of all MC pregnancy outcomes in a tertiary centre. Pregnancy outcomes were compared for monochorionic monoamniotic (MCMA) versus monochorionic diamniotic (MCDA) pregnancies. Results: 29 MCMA and 117 MCDA twin pregnancies were identified. The overall fetal loss rate was significantly higher in MCMA (23/52, 44.2%) compared to MCDA pregnancies (28/233, 12%, Chi squared = 30.03, p < .001). Kaplan-Meier analysis showed that fetal survival rate in MCDA twins were significantly higher than in MCMA twins (Log-rank Chi-squared = 27.9, p < .0005). Early pregnancy ultrasound identified the causes for these fetal losses in some MCMA twins. After exclusion of identifiable causes, the difference in fetal survival was not significant in the two groups (Log-rank chi-squared = 0.373, p = .54). Conclusion: The loss rate for MCMA twins is high and occurs mainly due to discordant congenital abnormality, conjoint twins or twin reversed arterial perfusion (TRAP) sequence. Although the fetal loss rate in MCDA is lower than in MCMA pregnancies, the majority of fetal loss in MCDA pregnancies cannot be predicted at the first scan at presentation. The data of this study questions the widespread policy of a difference in the scheduling of elective delivery for MCMA and MCDA twins.

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“…Intensive cardiotocographic monitoring may prevent some fetal deaths, but it is not surprising that it does not prevent all intrauterine death, as cord accidents can occur acutely without prior warning. Medical amnioreduction with sulindac, a non-selective prostaglandine synthase inhibitor used to treat preterm labor and polyhydramnios, was described to prevent the accumulation of a relative abundance of amniotic fluid that would otherwise allow unrestricted fetal movements and changes in fetal position, which contribute to the high intrauterine death rate from cord entanglement, compression and/or tightening of cord knots (Pasquini et al, 2006). …”

Section: Cord Entanglement In Monoamniotic Twinsmentioning

confidence: 99%