Monoamniotic twin pregnancies: antenatal management and perinatal results of 19 consecutive cases

Abstract

Objective To describe the obstetric management and perinatal outcome of antenatally diagnosed monoamniotic twin pregnancies (MATP) in a tertiary level maternity unit. Setting Port‐Royal Maternity Hospital, Paris, France. Population MATP that progressed beyond 22 weeks seen from 1993 to 2001. Methods A retrospective chart review of all twin pregnancies. Diagnosis of MATP was made by ultrasonography and confirmed by placental pathology. Main outcome measure Perinatal mortality. Results Among the 1242 twins pregnancies delivered during the study period, 19 were monoamniotic. Four fetuses (10% of all births) had malformations. Perinatal mortality was high (n= 12, 32%) because of fetal deaths (nine cases) and very preterm births (three neonatal deaths). No fetal deaths occurred after 29 weeks. Of the 15 women with at least one live fetus before labour, 6 gave birth by vaginal delivery (40%). No obstetric accidents occurred during vaginal deliveries. Conclusion Perinatal mortality of MATP is still very high, even with accurate, early antenatal diagnosis, intensified surveillance and delivery provided in a tertiary level hospital. The main causes of perinatal deaths are cord accidents in utero, congenital anomalies and very preterm births.

Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

“…However, once pregnancy abnormalities were excluded, the fetal loss rates in MCMA and MCDA pregnancies were not significantly different. It is accepted that the rate of fetal loss in MCMA twins is increased many-fold as compared to singleton pregnancies, with a perinatal mortality rate of 30-70% (Chitrit et al, 1999;Demaria et al, 2004;Powers & Kiely, 1994;Raphael, 1961;Timmons & Dealvarez, 1963). Since the loss rate of MC twins is also high, it is unclear whether the main reason for the high loss rate in MCMA twins is due to sharing the placenta and/or amniotic cavity.…”

“…MCMA pregnancies are also associated with a very high risk of pregnancy loss (Ezra et al, 2005;Roqué et al, 2003). The perinatal mortality rate in MCMA twins was originaly estimated to be 30-70% (Demaria et al, 2004;Raphael, 1961;Timmons & Dealvarez, 1963). This very high loss rate is presumed to be related to umbilical cord accidents, in particular cord entanglement (Allen et al, 2001).…”

Monochorionic monoamniotic twins: neonatal outcome

“…20 There have been reports of successful vaginal deliveries with entangled cords and with true umbilical cord knots. 21 How often entanglement associates with true umbilical cord knots is unclear. In our series, we observed true knots in five of 15 entangled cords, an incidence similar to that of Bajoria et al 20 (eight of 13), Rodis et al 16 (five of six) and Suzuki et al…”

“…8,20 We report TTS in three of the 36 MoMo pregnancies with an incidence of 10%, quite similar to that noted by others. 5,16,19,21,22 The presence of polyhydramnios, discordant fetal growth, hydrops, congestive heart failure, tricuspid regurgitation and discordant bladder fillings make the prenatal diagnosis of TTS possible. [8][9][10] Postnatal angiograms of the placenta demonstrating deep arteriovenous anastomoses with cotyledon sharing may confirm the diagnosis.…”

Embarazo Gemelar Monoamniótico: Experiencia De Una Serie De Casos en El Hospital Padre Hurtado

“…Es posible que esta evaluación no sea realizada en forma constante, y por ello, se subdiagnostique la condición de monoamniótico. La mortalidad perinatal de esta serie de casos fue de 14%, la cual es concordante con los reportes recientes de la literatura, que fluctúan entre 12 (4,5) y 31% (4,5,6). La Tabla III resume un gran número de casos publicados.…”