Monoamniotic twins: Improved perinatal survival with accurate prenatal diagnosis and antenatal fetal surveillance

Rodis, John F.; McIlveen, Peter; Egan, James; Borgida, Adam; Turner, Garry; Campbell, Winston A.

doi:10.1016/s0002-9378(97)70012-7

Cited by 114 publications

(71 citation statements)

References 4 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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“…3,14,15 MoMo pregnancies although rare (about one in every 10 000 pregnancies) have been reported to have a perinatal mortality as high as 68%. 16,17 Traditionally, these high perinatal losses have been attributed to umbilical cord entanglements, congenital malformations, TTS and prematurity. 4,5,16,17 Before 1990, the antenatal diagnosis of MoMo pregnancies was made in not more than half of the patients and for whom the majority of the deliveries were vaginal.…”

Section: Discussionmentioning

confidence: 99%

Monochorionic monoamniotic twins: neonatal outcome

2006

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Background: Monochorionic monoamniotic twins (MoMo) occur in one of 10 000 pregnancies. Cord entanglement, malformations, twin-to-twin transfusion syndrome (TTS) and prematurity are responsible for their high perinatal morbidity and mortality.Objective: To report our experience with 36 sets of MoMo twins (1990 to 2005) and to provide updated information for counseling.Methods: Chorionicity was determined by placental examination, gestational age and TTS clinically and by sonography. Intrauterine growth restriction (IUGR) was diagnosed with a twin-specific nomogram.Results: Cord entanglement was observed in 15 pregnancies, but only one twin with entanglement and a true knot, experienced related morbidity. Four of 71 live births were IUGR. Malformations were diagnosed prenatally (one hypoplastic left heart and one body stalk) and postnatally (one vertebral anomalies-anal atresia-tracheoesophageal fistula-renal defect (VATER) and two lung hypoplasias). Twin-to-twin transfusion syndrome affected three sets of twins. Five twin sets delivered before 31, 19 sets at 31 to 32 and 12 sets at 33 to 34 weeks. Six of 71 (8%) twins died (four malformations, one TTS and one 26 weeks premature). Head ultrasounds in 59 of 65 survivors showed two (3%) periventricular leukomalacia, five (9%) Grade I-II intraventricular hemorrhage and 52 (88%) normal.Conclusions: Monochorionic monoamniotic twins remain a group at risk for cord entanglement, congenital malformations, TTS and prematurity. Although their neonatal mortality and morbidity is high, outcomes for survival are better than anticipated.

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“…Both corresponding co-twins developed uneventfully (Table 1). Most authors agree that intensified fetal surveillance with fetal heart rate monitoring, Doppler ultrasound and even hospitalization when viability is reached can lead to improved outcome 2,7,8 . Early gradual strangulation of the umbilical cords might thus be detected by intense surveillance, and immediate delivery might prevent perinatal complications.…”

Section: Is the Location Of Cord Entanglement Associated With Anteparmentioning

confidence: 99%