Management of monoamniotic twins: the question is not ‘where?’, but ‘how?’

Mieghem, Tim Van; Shub, Alexis

doi:10.1002/uog.20203

Cited by 13 publications

(7 citation statements)

References 24 publications

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“…As for the risk of perinatal death, this can be reduced by aiming to deliver at around 32 weeks' gestation 37,38 . The outcome may not be different if monitoring after 26 weeks' gestation is carried out on an outpatient basis compared to hospitalization [39][40][41] .…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Outcome of twin pregnancy with two live fetuses at 11–13 weeks' gestation

Litwińska

Syngelaki

Cimpoca-Raptis

et al. 2019

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? This study of 6225 twin pregnancies with two live fetuses at 11-13 weeks' gestation and no major abnormalities, first, compares overall survival, fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks, delivery at < 37 and < 32 weeks, and birth weight < 5 th percentile between dichorionic, monochorionic diamniotic and monochorionic monoamniotic twins, and, second, examines the potential impact of endoscopic laser surgery for severe twin-twin transfusion syndrome and/or selective fetal growth restriction on the outcome of monochorionic diamniotic twins. What are the clinical implications of this work?In twin pregnancy, determination of chorionicity and amnionicity at the routine 11-13-week scan is essential because this defines the subsequent pregnancy outcome and the need for surveillance and intervention. ABSTRACTObjectives To report and compare pregnancy outcome in dichorionic (DC), monochorionic diamniotic (MCDA) and monochorionic monoamniotic (MCMA) twin pregnancies with two live fetuses at 11-13 weeks' gestation and to examine the impact of endoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) and/or selective fetal growth restriction (sFGR) on the outcome of MCDA twins.Methods This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation between 2002 and 2019. In pregnancies with no major abnormalities, we compared overall survival, fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks, delivery at < 37 and < 32 weeks, and birth weight < 5 th percentile between DC, MCDA and MCMA twins. ResultsThe study population of 6225 twin pregnancies with two live fetuses at 11-13 weeks' gestation with no major abnormalities included 4896 (78.7%) DC, 1274 (20.5%) MCDA and 55 (0.9%) MCMA twins. In DC twins, the rate of loss at < 24 weeks' gestation in all fetuses was 2.3%; this rate was higher in MCDA twins (7.7%; relative risk (RR), 3.258; 95% CI, and more so in MCMA twins (21.8%; RR, 9.289; 95% CI,). In DC twins, the rate of perinatal death at ≥ 24 weeks in all twins that were alive at 24 weeks was 1.0%; this rate was higher in MCDA twins (2.5%; RR, 2.456; 95% CI,) and more so in MCMA twins (9.3%; RR, 9.130; 95% CI,. In DC twins, the rate of preterm birth at < 37 weeks' gestation in pregnancies with at least one liveborn twin was 48.6%; this rate was higher in MCDA twins (88.5%; RR, 1.824; 95% CI, 1.760-1.890) and more so in MCMA twins (100%; RR, 2.060; 95% CI, 2.000-2.121). In DC twins, the rate of preterm birth at < 32 weeks was 7.4%; this rate was higher in MCDA twins (14.2%; RR, 1.920; 95% CI,) and more so in MCMA twins (26.8%; RR, 3.637; 95% CI,. In DC twin pregnancies with at least one liveborn twin, the rate of a small-for-gestational-age neonate among all liveborn twins was 31.2% and in MCDA twins this rate was higher (37.8%; RR, 1.209; 95% CI,; in MCMA twins, the rate was not significantly different (33.3%; RR, 1.067; 95...

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Section: Implications For Clinical Practicementioning

confidence: 99%

Outcome of twin pregnancy with two live fetuses at 11–13 weeks' gestation

Litwińska

Syngelaki

Cimpoca-Raptis

et al. 2019

Ultrasound in Obstet & Gyne

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“…The results suggested that perinatal mortality rate was lower in the inpatient group, but the results were inconclusive. However, this has been contradicted by others [18]. The hemodynamic instability between the two fetuses is a causal factor behind sudden fetal demise in these pregnancies.…”

Section: Discussionmentioning

confidence: 90%

Perinatal outcome in monoamniotic twin pregnancies during a 10-year period: a single center, descriptive study

Söderhult

Tiblad

Herling

2022

Arch Gynecol Obstet

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Purpose To retrospectively investigate perinatal outcome of monoamniotic twin pregnancies in a tertiary center during a 10 year period. Methods A retrospective analysis of all monoamniotic pregnancies managed at Karolinska University Hospital, Stockholm, Sweden 2010–2019 was performed. The primary outcomes were live birth rate, neonatal death and perinatal survival. The secondary outcomes were late miscarriage, gestational age at delivery and frequency of fetal complications. Results Twenty-two monoamniotic pregnancies, with 44 fetuses, were identified. Thirty-five of 44 fetuses (80%) were liveborn. Of 36 fetuses reaching 24 weeks gestation, 35 (97%) were liveborn. There were no neonatal deaths, thus the perinatal survival was 97%. The mean gestational age at birth was 32.5 weeks (SD ± 1.5). Conclusions The live birth rate and perinatal survival of monoamniotic pregnancies managed at Karolinska University Hospital was high and comparable to previously published data.

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“…The appropriate management of monoamniotic twins is still unclear and varies among clinicians [ 3 ]. There appears to be agreement that prior to viability, early confirmation of chorionicity and amnionicity, as well as identification of fetal anomalies should be performed [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Inpatient Management of a Monoamniotic Twin Pregnancy Complicated by Umbilical Cord Entanglement and Selective Intrauterine Growth Restriction

Gomez¹,

Woodroffe²

2022

Cureus

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Monoamniotic twin pregnancies are exceedingly rare. These are high-risk pregnancies that present a unique set of challenges for the obstetrician-gynecologist. There is a high risk of intrauterine fetal demise, secondary to co-morbid conditions including, but not limited to, congenital anomalies and umbilical cord entanglement. Successful delivery and favorable neonatal outcomes are predicated on early diagnosis, intensive fetal monitoring, and timely delivery. The management guidelines for these pregnancies rely primarily on retrospective studies and expert consensus, although some substantial conclusions can be made regarding appropriate antepartum and intrapartum care. We present the case of a 38-year-old gravida four, para three, with monoamniotic twins who delivered successfully after inpatient hospitalization at viability, administration of corticosteroids for fetal lung maturity, and vigilant fetal monitoring. We conclude that the combination of early ultrasound, intensive fetal monitoring, and interdisciplinary coordination among generalist obstetrician-gynecologists, maternal-fetal medicine specialists, and nursing staff is paramount for providing the greatest chance of a favorable outcome.

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Management of monoamniotic twins: the question is not ‘where?’, but ‘how?’

Abstract: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.19179

Cited by 13 publications

References 24 publications

Outcome of twin pregnancy with two live fetuses at 11–13 weeks' gestation

Outcome of twin pregnancy with two live fetuses at 11–13 weeks' gestation

Perinatal outcome in monoamniotic twin pregnancies during a 10-year period: a single center, descriptive study

Inpatient Management of a Monoamniotic Twin Pregnancy Complicated by Umbilical Cord Entanglement and Selective Intrauterine Growth Restriction

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