Inpatient <i>vs</i> outpatient  management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study

Saccone, Gabriele

doi:10.1002/uog.19179

Cited by 43 publications

(18 citation statements)

References 31 publications

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“…A recent meta-analysis showed that inpatient monitoring had a 3% risk of IUD (95% CI 1.4-5.2%), where outpatient management had a higher IUD risk of 7.4% (95% CI 4.4-11.1%) 67 . However, a multicentre cohort study observed no significant difference in perinatal mortality between the inpatient and outpatient managed groups of MCMA twins (adjusted OR 0.21, 95% CI 0.04-1.17) 68 . Recommendations on timing of birth have varied between 32-36 weeks.…”

Section: Controversies In the Management Of Mcma Twin Pregnanciesmentioning

confidence: 92%

Controversies in the management of twin pregnancy

Khalil

Liu

2021

Ultrasound in Obstet & Gyne

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Despite many advances in antenatal care, twin pregnancies still experience more adverse outcomes, in particular higher perinatal mortality and morbidity. They also pose a multitude of challenges and controversies as outlined in this paper. Moreover, they are less likely to be included in clinical trials. Many issues on classification and management remain under debate. Efforts on standardising diagnostic criteria, monitoring protocols, management and outcome reporting are likely to reduce their perinatal risks. The top 10 most important research uncertainties related to multiple pregnancies have been identified by both clinicians and patients. More robust research in the form of randomised trials and large well-conducted prospective cohort studies are needed to address these controversies.

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Section: Controversies In the Management Of Mcma Twin Pregnanciesmentioning

confidence: 92%

Controversies in the management of twin pregnancy

Khalil

Liu

2021

Ultrasound in Obstet & Gyne

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“…The primary outcome was intrauterine fetal death. 42 Out of 195 pregnancies (390 fetuses), the overall perinatal loss rate was 10.8% (peak fetal death rate at 29 weeks of gestation, reaching 4.3%). From 32 0/7 to 36 6/7 , no fetal or neonatal deaths were recorded.…”

Section: Timing Of Deliverymentioning

confidence: 99%

Mode of delivery in multiple pregnancies

Aviram¹,

Barrett²,

Melamed³

et al. 2022

American Journal of Obstetrics & Gynecology MFM

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The perinatal mortality of MCMA twin pregnancies is high and ranges from 10% to 40% 57,58,62,63 . However, recent data suggest a rate of about 10%, resulting from a better prenatal diagnosis, repeated fetal monitoring, and elective preterm delivery 64 …”

Section: Umbilical Cord Abnormalities Related To Monochorionic Twin G...mentioning

confidence: 99%

“…The Monochorionic Monoamniotic (MONOMONO) study also reported that fetal monitoring is essential to achieve good outcomes in MCMA pregnancies, regardless of the surveillance setting. 64 In 2020, the Society for Maternal-Fetal Medicine(SMFM) Special Statement published a checklist for managing MCMA pregnancies that featured serial ultrasound starting from 16 weeks of gestation; every two weeks for the assessment of amniotic fluid volume and bladder filling, and every two to four weeks for the evaluation of fetal growth. A detailed fetal anatomy survey should be performed at 18 to 22 weeks of gestation (or earlier if technically feasible) and a fetal echocardiogram should be performed at 18 to 22 weeks of gestation.…”

Section: Umbilical Proximate Cord Insertion (Pci)mentioning

confidence: 99%

The Umbilical Cord and Complications of Twin Gestations

et al. 2022

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The rate of twin pregnancies has increased over the last decades, largely because of the ongoing development of assisted reproductive technology and increased maternal age at childbearing. Twins have a higher risk of adverse outcomes during pregnancy and the perinatal period. The prevalence of umbilical cord abnormalities is higher for twin pregnancies compared with singleton pregnancies. Some of these abnormalities are nonspecific to twinning and can also be found in singleton gestations (such as velamentous cord insertion, vasa previa, and single umbilical artery). Other abnormalities are associated with monochorionic twins, such as umbilical cord entanglement, and umbilical proximate cord insertion. Most of these abnormalities can be detected by ultrasound evaluation. The early and accurate ultrasound diagnosis of chorionicity, amnionicity, and placental and umbilical cord characteristics is crucial if we are to predict the risk of complications and to determine the best management for twin pregnancies. Histopathological examination of the placenta and umbilical cord after delivery can help to confirm prenatal diagnosis and to provide a better understanding of the physiopathology of their abnormalities. The aim of this review was to emphasize the role that the umbilical cord plays in twin complications and to describe the management of these high-risk pregnancies.

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Inpatient vs outpatient management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study

Cited by 43 publications

References 31 publications

Controversies in the management of twin pregnancy

Controversies in the management of twin pregnancy

Mode of delivery in multiple pregnancies

The Umbilical Cord and Complications of Twin Gestations

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