Perinatal outcome and clinical features of monochorionic monoamniotic twin gestation

Abstract

Perinatal outcomes in our study were relatively good irrespective of high frequency of cord entanglement. Close fetal monitoring may allow MM twin pregnancies to extend gestational age, which may contribute to reduce both fetal death and neonatal morbidity by immaturity, although the best delivery weeks remained undetermined.

Prenatal diagnosis and management of monoamniotic twins

“…Studies before the 1990s reported a mortality rate above 40% in such twins [1]. Our previous study found an overall survival rate of 75% in monoamniotic twins, not counting those with fetal malformations or reversed twin arterial perfusion sequence [7], which was consistent with results found by Hack et al [5] in their study of monoamniotic twin mortality during the previable period. However, recent studies have reported improved perinatal survival rates.…”

“…Most deaths were caused by compromised fetal circulation due to umbilical cord entanglement or by congenital malformations, the latter being present in up to 26% of monoamniotic pregnancies [12]; complications commonly seen in diamniotic twins, such as twin-twin transfusion syndrome, seem to be less frequent in monoamniotic twins [5,7,8 & ,13,14]. Our recent study found a perinatal mortality rate of 2% among monoamniotic twins, excluding those with fetal malformations and those who were lost before becoming viable [7], which was similar to rates reported by Allen et al [3] and Baxi and Walsh [15] (2.8 and 2.4%, respectively). Our previous study found an overall survival rate of 75% in monoamniotic twins, not counting those with fetal malformations or reversed twin arterial perfusion sequence [7], which was consistent with results found by Hack et al [5] in their study of monoamniotic twin mortality during the previable period.…”

“…However, several recent studies have found a perinatal mortality rate of 19% or less and, in particular, a low incidence of perinatal loss related to umbilical cord entanglement [5-7,8 & ]. Several authors have speculated that the improved perinatal survival rate among monoamniotic twins might be a result of intensive fetal surveillance [3,7,[9][10][11]. However, the optimal antenatal care setting (inpatient or outpatient) and the optimal timing of delivery have not been established for monoamniotic twin pregnancies.…”

Prenatal Management of Monoamniotic Twin Pregnancies

“…ine and neonatal death with perinatal mortality ranging between 10 and 40%. [1][2][3][4][5][6] This high perinatal mortality rate is partially the result of an increased incidence in congenital anomalies (up to 26%) 1 as well as to twin-reversed-arterial-perfusion sequence and conjoined twinning. 7 Another contributor to perinatal mortality in monoamniotic twins is the fact that two fetuses share a single placenta and a single amniotic cavity.…”

STUDY OF OBSTETRIC COMPLICATIONS & OUTCOME OF TWIN PREGNANCY

“…Murata et al (2013) 21 studied perinatal outcome of monochorionic monoamniotic twin gestation. In the study of 38 MM twin pregnancies (76 fetuses), the perinatal mortality rate was 2%and the neuro morbidity rate was 8% The overall survival rate was 75%.…”