Monitoring Methods for Monoamniotic Twin Pregnancies: Multicenter Retrospective Study of 149 Cases

Monoamniotic twins is rare and associated with a high rate of perinatal morbidity and mortality. In addition to the common risks, more specific complications, cord entanglement in particular, worsen their prognosis. The literature about the optimal gestational age for birth and mode of delivery is still conflicting. To evaluate strategy used in France for the prenatal and intrapartum management monoamniotic twin pregnancies in France.This retrospective multicenter study retrieved the strategies and outcomes for 149 monoamniotic twin pregnancies from 10 university hospitals in France over an 18-year period. Two methods of managing the follow-up methods of these pregnancies with a propensity score were distinguished: follow-up in a participating maternity unit as an inpatient or outpatient. Two populations were analyzed: inpatients and outpatients were compared among all pregnancies and fetuses from 26^0/7 to 34^6/7 weeks of gestation (n = 92). All pregnancies and fetuses not born after 35^0/7 weeks of gestation (n = 57) were analyzed separately. The primary endpoints were intrauterine and perinatal mortality rates.Perinatal mortality didn't differ between the 38 inpatient and 54 outpatient pregnancies (15.8 vs. 14.8%). The same was true for all fetuses and newborns with 7 deaths out of 76 (9.2% for inpatients) and 10 deaths out of 108 (9.2% for outpatients, p = 0.99). Finally, 57 pregnancies (33%) continued past 35 weeks. One death in utero was observed at 20 weeks and only one other at 35 weeks (1.5%).This study shows no differences between inpatient and outpatient management and suggests that some perinatal centers envision continuing these pregnancies past 35 weeks. Vaginal delivery is not strictly contraindicated, although cesarean delivery is safe and most often recommended. · Monoamniotic twin pregnancies are rare with an elevated risk of fetal and neonatal mortality.. · To monitor the risk factors closely, they can be managed either as inpatients or outpatients.. · Delivery, most often by cesarean, around 32 to 34 weeks, is recommended because of the rare but avoidable and thus especially distressing in utero deaths.. · Controversy persists, nonetheless, about management (inpatient or outpatient), optimal gestation age for delivery, and mode of delivery.