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Updated: Jul 31, 2026

Guide Wire Assisted Catheterization and Colored Dye Injection for Vascular Mapping of Monochorionic Twin Placentas
Published on: September 5, 2011
Monoamniotic twinning and zona manipulation: a survey of U.S. IVF centers correlating zona manipulation procedures
1Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk 23508, USA.
Purpose:
An anonymous survey of IVF centers in the United States was employed to calculate frequencies of multiple gestation, monozygotic multiple gestation, and monoamniotic multiple gestation. Rates for zona-manipulated (ICSI, SUZI, zona drilling, mechanical assisted hatching) and non-manipulated pregnancies were compared.
Results:
From 42 IVF centers in the United States, a total of 143 pregnancies was ascertained from zona-manipulated cycles. A multiple gestation frequency of 16.1% was reported. Five monoamniotic twin gestations were identified: four from manipulated cycles and one from a nonmanipulated cycle. All monoamniotic twin gestations resulted in live births, although three showed significant intrauterine growth discordance and one newborn was diagnosed with the VATER malformation sequence.
Conclusions:
Monoamniotic multiple gestations may be increased in zona-manipulated cycles. The potential obstetric risks and complications of zona manipulation should be discussed with patients.
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