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2 results

  • Chapter 17 - Management of Monoamniotic Twins

  • Edited by Leanne Bricker, Julian N. Robinson, Baskaran Thilaganathan, St George's Hospital Medical School, University of London
  • Book:
    Management of Multiple Pregnancies
    Published online:
    11 October 2022
    Print publication:
    27 October 2022, pp 181-187

  • Summary

    In monochorionic monoamniotic twin pregnancies, two fetuses share a single placenta and a single amniotic cavity. This unique anatomic configuration, although rare, puts them at high risk for a number of complications including structural anomalies, twin-twin transfusion syndrome, selective intra-uterine growth restriction and cord accidents. Early diagnosis and patient counselling are therefore crucial. Level 1 evidence on the optimal management of monoamniotic twins is lacking, but observational studies provide some guidance for best practice. In uncomplicated monoamniotic twins, after viability, fetal mortality is less than 5% if close surveillance is initiated. This can be done in either an inpatient or outpatient setting. If all goes well, monoamniotic twins should be delivered from 33 weeks’ gestation as, at that timepoint, the risk of in utero death is larger than the risk of (non-respiratory) neonatal complications.

  • Monoamniotic Twin Pregnancy

  • R.H. Lumme, S.V. Saarikoski
  • Journal:
    Acta geneticae medicae et gemellologiae: twin research / Volume 35 / Issue 1-2 / April 1986
    Published online by Cambridge University Press:
    01 August 2014, pp. 99-105
    Print publication:
    April 1986
    • Article
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  • The course and outcome of 23 monoamniotic (MA) twin pregnancies, delivered in Tampere University Central Hospital during the years 1964-1984, were studied retrospectively and compared to 1056 diamniotic (DA) twin pregnancies. The frequency of MA twins was 2.1% of twin pregnancies. Polyhydramnion complicated the pregnancy in 26% of MA vs 6% of DA pregnancies. Two cases were defined as acute polyhydramnion. Preterm labour was stated in 70% of MA pregnancies and deliveries before the 34th week were 4 times more common in MA than DA pregnancies. The cesarean section rate was more than double in MA pregnancies (39%). Entanglement of the umbilical cords was noted four times, and prolapse of the cord in three vaginally delivered cases. Perinatal mortality was 28% in MA vs 5% in DA twins. The most common causes of death were respiratory distress syndrome, congenital malformation and feto-fetal transfusion.