Perinatal outcomes in monoamniotic gestations

Roqué, Henry; Gillen-Goldstein, Jonathan; Funai, Edmund F.; Young, Bruce K.; Lockwood, Charles J.

doi:10.1080/jmf.13.6.414.421

Cited by 99 publications

(67 citation statements)

References 55 publications

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“…[17][18][19] The absence of umbilical cord accidents and the low incidence of perinatal depression among our twins may be a positive reflection of the mode of delivery.…”

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confidence: 99%

“…Although optimal time is still controversial, most management strategies including ours favor delivery no later than 32 to 34 weeks of gestation. [17][18][19] Premature infants, especially those born before 32 weeks of gestation, have a high incidence of perinatal depression, respiratory distress, early-and late-onset sepsis, patent ductus arteriosus, necrotizing enterocolitis, intracranial hemorrhage, prolonged hospitalization and poor neurological outcomes. 27 Data provided here (Table 3) highlight low mortality, but still document the significant morbidities associated with premature deliveries.…”

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confidence: 99%

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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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“…[17][18][19] The absence of umbilical cord accidents and the low incidence of perinatal depression among our twins may be a positive reflection of the mode of delivery.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Monochorionic monoamniotic twins: neonatal outcome

2006

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“…Monochorionic monoamniotic (MCMA) twins account for approximately 1% of monozygotic twins with a reported incidence ranging from 1:1650 to 1:93734 live births (Aisenbrey et al, 1995;D'Alton & Simpson, 1995;Derom et al, 1988;Colburn & Pasquale, 1982;Simonsen, 1966). 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).…”

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confidence: 99%

Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

et al. 2011

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Objective: To compare the fetal loss rate of monochorionic (MC) twin pregnancies according to their amnionicity. Methods: A retrospective review of all MC pregnancy outcomes in a tertiary centre. Pregnancy outcomes were compared for monochorionic monoamniotic (MCMA) versus monochorionic diamniotic (MCDA) pregnancies. Results: 29 MCMA and 117 MCDA twin pregnancies were identified. The overall fetal loss rate was significantly higher in MCMA (23/52, 44.2%) compared to MCDA pregnancies (28/233, 12%, Chi squared = 30.03, p < .001). Kaplan-Meier analysis showed that fetal survival rate in MCDA twins were significantly higher than in MCMA twins (Log-rank Chi-squared = 27.9, p < .0005). Early pregnancy ultrasound identified the causes for these fetal losses in some MCMA twins. After exclusion of identifiable causes, the difference in fetal survival was not significant in the two groups (Log-rank chi-squared = 0.373, p = .54). Conclusion: The loss rate for MCMA twins is high and occurs mainly due to discordant congenital abnormality, conjoint twins or twin reversed arterial perfusion (TRAP) sequence. Although the fetal loss rate in MCDA is lower than in MCMA pregnancies, the majority of fetal loss in MCDA pregnancies cannot be predicted at the first scan at presentation. The data of this study questions the widespread policy of a difference in the scheduling of elective delivery for MCMA and MCDA twins.

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“…Se ha descrito en la literatura que el momento ideal para la interrupción es a las 32 semanas de edad gestacional, posteriormente la mortalidad fetal aumenta y se produce una marcada disminución de las complicaciones neonatales (70). Se recomienda la interrupción por operación cesárea electiva ya que se evitaría el atrapamiento de cordón o el corte inadvertido del cordón del segundo gemelo que podría estar alrededor del cuello del primero.…”

Section: Síndrome De Transfusión Feto-fetal (Stff)unclassified

Pautas De Manejo Clínico De Embarazos Gemelares

Becker

2009

Rev. chil. obstet. ginecol.

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RESUMENEl embarazo gemelar conlleva un elevado riesgo de morbilidad y mortalidad perinatal. Teniendo el control prenatal una reconocida utilidad en disminuir la morbimortalidad perinatal, decidimos elaborar pautas de manejo clínico, basadas en evidencia, que orienten el seguimiento prenatal de embarazos gemelares. Realizamos una revisión de las publicaciones recientes, guías clínicas y textos clásicos de obstetricia obteniendo la información necesaria. Presentamos un listado de las recomendaciones y la calidad de evidencia que las sustenta, respecto de seis ítems: a. Reproducción asistida; b. Diagnóstico de embarazo gemelar; c. Manejo general del embarazo gemelar; d. Parto prematuro; e. Complicaciones específicas de embarazos gemelares; y f. Momento de interrupción y manejo del trabajo de parto. PALABRAS CLAVE: Embarazo múltiple, embarazo gemelar, guías clínicas SUMMARYMultiple pregnancy has high risk of perinatal morbidity and mortality. Since antenatal care has been demonstrated as a useful tool in reducing perinatal risk, we decided to elaborate evidence based clinical guidelines, to facilitate antenatal care of women carrying multiple pregnancies. We reviewed recent publications, clinical guidelines and text books to obtain necessary information. Here we present a list of recommendations, and the quality of supporting evidence, about six items: a. Assisted reproduction; b. Diagnosis of multiple pregnancy; c. General care of multiple pregnancy; d. Preterm Labor; e. Specific complications of multiple pregnancy; f. Timing of delivery and labor management. KEY WORDS: Multiple pregnancy, twin pregnancy, guidelines INTRODUCCIÓNLa incidencia de embarazos múltiples ha aumentado dramáticamente en las últimas décadas en los países desarrollados, desde 1 por 100 nacidos vivos a 1 por 70 nacidos vivos, con un aumento de un 40% en la tasa de embarazos gemelares y un aumento de 3 a 4 veces en embarazos múlti-ples de alto orden. Este aumento en el número de embarazos múltiples es atribuible en mayor parte a la utilización de técnicas de reproducción asistida, pero también se explica por un aumento en la edad materna, ya que existe asociación entre la edad materna y la tasa de gestaciones múltiples concebidas espontáneamente (1).El embarazo múltiple es un embarazo de alto riesgo fetal, pues tiene, entre otros problemas, mayor incidencia de prematurez, restricción del crecimiento fetal, malformaciones congénitas y muerte fetal in útero comparado con las gestaciones úni-cas. Existen además, complicaciones propias del embarazo gemelar como: crecimiento discordante, muerte in útero de alguno de los gemelos, síndrome de transfusión feto-fetal, gemelos monoamnióticos

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Perinatal outcomes in monoamniotic gestations

Abstract: Contrary to previous reports, there is a significant increase in the incidence of perinatal loss beyond 32 weeks among monoamniotic twins, suggesting that delivery after corticosteroid therapy should be strongly considered at this gestational age.

Cited by 99 publications

References 55 publications

Monochorionic monoamniotic twins: neonatal outcome

Monochorionic monoamniotic twins: neonatal outcome

Pregnancy Outcome of Monochorionic Twins: Does Amnionicity Matter?

Pautas De Manejo Clínico De Embarazos Gemelares

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