Monoamniotic Twins: What Should Be the Optimal Antenatal Management?

Cord entanglement and perinatal outcome in monoamniotic twin pregnancies

“…More recent literature has variably reported the prevalence of cord entanglement from as low as 42 up to 95%5, 13. This variation may be explained by the fact that most of these studies were retrospective and did not systematically evaluate the pregnancy for cord entanglement5, 6, 8, 9. Furthermore, some pregnancies used incidental reporting at birth to identify the presence of cord entanglement, which may introduce bias and under‐reporting5.…”

“…Previous studies have consistently emphasized the high perinatal loss rate in monoamniotic twins6, 8, 9. Neonatal survival rates in expectantly managed monoamniotic twins have varied enormously, even in the recent literature, from 58 to 92%5, 6.…”

“…The perinatal loss rate in monoamniotic twins has been reported as varying from 8 to as high as 42%5, 6. The high perinatal loss rates have been attributed mainly to umbilical cord entanglement, intertwin transfusion syndromes, discordant fetal abnormality or growth restriction7–11. The largest recent review of the monoamniotic twin literature included 60 studies conducted over a 12‐year period, most published before 200010.…”

Prenatal diagnosis and management of monoamniotic twins

“…Our previous study of monoamniotic twin pregnancies found umbilical cord entanglement in 88% of pregnancies and 65% of 17 fetal deaths [7]; however, reported rates of fetal death caused by umbilical cord entanglement vary among studies [3][4][5][6][7]10,11,15,16]. Our previous study of monoamniotic twin pregnancies found umbilical cord entanglement in 88% of pregnancies and 65% of 17 fetal deaths [7]; however, reported rates of fetal death caused by umbilical cord entanglement vary among studies [3][4][5][6][7]10,11,15,16].…”

Monoamniotic twin pregnancy

“…Additionally, it is difficult to postulate how anything other than continuous cardiotocography throughout the antenatal period can diagnose imminent fetal demise early enough for effective intervention. Interestingly, improved perinatal survival has been reported in several series in which monoamniotic twins were managed on an outpatient basis …”