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[Monoamnotic twin pregnancy. Multicenter study].
Witold Malinowski1, Elzbieta Baś-Budecka, Marek Bilar
1Zakład Profilaktyki w Ginekologii i Poloinictwie AS w Kielcach.
Ginekologia Polska
|June 2, 2006
Summary
Monoamniotic twins face high risks of pregnancy complications and fetal loss. However, inpatient fetal monitoring for these high-risk pregnancies can significantly improve neonatal survival and reduce perinatal morbidity.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Obstetrics
Context:
- Monoamniotic twins, characterized by a shared amniotic sac, present unique and significant risks during pregnancy.
- Previous research indicates a high incidence of complications, necessitating careful evaluation and management strategies.
Purpose:
- To evaluate the perinatal mortality and morbidity associated with monoamniotic twin gestations.
- To assess the effectiveness of inpatient fetal monitoring in improving outcomes for these high-risk pregnancies.
Summary:
- A multicenter retrospective analysis of 26 monoamniotic twin gestations revealed an overall loss rate of 52% and a perinatal mortality rate of 19.4%.
- Prenatal diagnosis via ultrasound was reliable in most cases. Elective inpatient fetal monitoring for 11 women starting at 26-27 weeks resulted in 2 neonatal deaths, with no intrauterine fetal deaths occurring in this monitored group.
- Complications included 100% prematurity, 38.5% umbilical cord entanglement, 23% twin-to-twin transfusion syndrome (TTTS), 3.6% twin reversed arterial perfusion (TRAP) sequence, and 9.6% fetal congenital anomalies.
Impact:
- Monoamniotic twin pregnancies are at extreme risk, but reliable ultrasound diagnosis is achievable.
- Elective inpatient fetal monitoring demonstrates potential to significantly improve neonatal survival and decrease perinatal morbidity in monoamniotic twin pregnancies.