Journal List > Korean J Obstet Gynecol > v.53(10) > 1006481

TOOLS
Jo, Ko, Jang, Choi, Son, Kim, Shin, and Lee: The perinatal outcome of monoamniotic twin pregnancies
Original Article
Korean Journal of Obstetrics and Gynecology

Korean Journal of Obstetrics and Gynecology 2010; 53(10): 881-887.

Published online: 31 October 2010

DOI: https://doi.org/10.5468/kjog.2010.53.10.881

The perinatal outcome of monoamniotic twin pregnancies

Yun Sung Jo, M.D., Hyun Sun Ko, M.D., Dong Gyu Jang, M.D., Youn Jin Choi, M.D., Hyen Ju Son, M.D., Sa Jin Kim, M.D., Ph.D., Jong Chul Shin, M.D., Guisera Lee, M.D.

Department of Obstetrics and Gynecology, St. Vincent's Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea.

Corresponding author (leegsr@catholic.ac.kr)

Received 9 July 2010       Accepted 9 August 2010

Copyright © 2010 Korean Society of Obstetrics and Gynecology

Abstract

Objective

The purpose of this study was to determine the perinatal outcome in monoamniotic twin pregnancies and to review the recently published literature about the topic.

Methods

This retrospective study examined the records of prenatally diagnosed monoamniotic twin pregnancy casese in our institution between January 1997 and April 2010.

Results

Among 1,112 twin pregnancies, there were 15 (1.3%) monoamnionic twins, including 2 conjoined twin pregnancies. Twelve (80%), 9 (60%), 5 (33.3%), and 4 pregnancies (26.7%) delivered after 20, 30, 32, and 34 weeks, respectively. Among 12 pregnancies that continued after 20 weeks of gestation, three cases showed one-fetal death and one, both-fetal death. The perinatal mortality rate (from 20 weeks of gestation to 28 days after birth) was 37.5%. The incidence of lethal anomalies and congenital heart anomalies was 20% and 23.3%, respectively. The mean gestational age at delivery was 31.4±4.53 weeks; 16 of 18 neonates (84.2%) were admitted to the neonatal intensive care unit (NICU). Three neonates expired on the first day after birth. The mean duration of the NICU stays for 13 live neonates was 32.0±29.3 days (range, 3 to 114 days). The main causes of perinatal deaths were preterm birth, congenital anomalies, pregnancy loss before 20 weeks, and intrauterine fetal demise that might have resulted form cord entanglement.

Conclusion

Perinatal mortality in monoamniotic twins was still very high and the survival rate after 32 weeks of gestation is approximately one-third. Further studies are needed to improve the perinatal mortality.

Keywords: Twin, Monoamniontic twin, Intrauterine fetal dea, Perinatal outcome

Figures and Tables

Table 1
15 cases of monoamniotic twins
kjog-53-881-i001

FDIU: intrauterine fetal death, GA: gestational weeks, A/S: apgar score, NICU: neonatal intensive care unit, T1: first baby, T2: second baby, VD: vaginal delivery, ASD: atrial septal defect, CS: cesarean delivery, F: female, M: male, PS: pulmonary stenosis, VSD: ventricular septal defect.

Table 2
Maternal characteristics
kjog-53-881-i002

IIOC: incompetent internal os of cervix, PPROM: preterm premature rupture of membrane, TTTS: twin to twin transfusion syndrome.

Table 3
Perinatal outcome
kjog-53-881-i003

Values are presented as mean±standard deviation (SD) or number (%). NICU: neonatal intensive care unit.

Table 4
Neonatal outcome by mode of delivery
kjog-53-881-i004

Values are presented as mean ± standard deviation (SD) or number (%).

CS: cesarean delivery, VD: vaginal delivery, A/S: apgar score.

References

1. Pijnenborg JM, Oei SG. The monoamniotic twin: a riskful event. Eur J Obstet Gynecol Reprod Biol. 1999. 86:51–53.
2. Benirschke K, Kim CK. Multiple pregnancy-1. N Engl J Med. 1973. 288:1276–1284.
3. Quigley JK. Monoamniotic twin pregnancy. Am J Obstet Gynecol. 1935. 29:354–362.
4. Slotnick RN, Ortega JE. Monoamniotic twinning and zona manipulation: a survey of U.S. IVF centers correlating zona manipulation procedures and highrisk twinning frequency. J Assist Reprod Genet. 1996. 13:381–385.
5. Benirschke K. Creasy RK, Resnik R, Iams J, editors. The biology of twinning. Maternal-Fetal medicine: principle and practice. 2003. 5th ed. Philadelphia, PA: W.B.Saunders;55–68.
6. Cordero L, Franco A, Joy SD. Monochorionic monoamniotic twins: neonatal outcome. J Perinatol. 2006. 26:170–175.
7. Ezra Y, Shveiky D, Ophir E, Nadjari M, Eisenberg VH, Samueloff A, et al. Intensive management and early delivery reduce antenatal mortality in monoamniotic twin pregnancies. Acta Obstet Gynecol Scand. 2005. 84:432–435.
8. Allen VM, Windrim R, Barrett J, Ohlsson A. Management of monoamniotic twin pregnancies: a case series and systematic review of the literature. BJOG. 2001. 108:931–936.
9. Hack KE, Derks JB, Schaap AH, Lopriore E, Elias SG, Arabin B, et al. Perinatal outcome of monoamniotic twin pregnancies. Obstet Gynecol. 2009. 113:353–360.
10. Roque H, Gillen-Goldstein J, Funai E, Young BK, Lockwood CJ. Perinatal outcomes in monoamniotic gestations. J Matern Fetal Neonatal Med. 2003. 13:414–421.
11. Sau AK, Langford K, Elliott C, Su LL, Maxwell DJ. Monoamniotic twins: what should be the optimal antenatal management? Twin Res. 2003. 6:270–274.
12. Su LL. Monoamniotic twins: diagnosis and management. Acta Obstet Gynecol Scand. 2002. 81:995–1000.
13. Bruner JP, Rosemond RL. Twin-to-twin transfusion syndrome: a subset of the twin oligohydramniospolyhydramnios sequence. Am J Obstet Gynecol. 1993. 169:925–930.
14. Lumme RH, Saarikoski SV. Perinatal deaths in twin pregnancy: a 22-year review. Acta Genet Med Gemellol (Roma). 1988. 37:47–54.
15. Demaria F, Goffinet F, Kayem G, Tsatsaris V, Hessabi M, Cabrol D. Monoamniotic twin pregnancies: antenatal management and perinatal results of 19 consecutive cases. BJOG. 2004. 111:22–26.
16. Pasquini L, Wimalasundera RC, Fichera A, Barigye O, Chappell L, Fisk NM. High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation. Ultrasound Obstet Gynecol. 2006. 28:681–687.
17. Simonsen M. Monoamniotic twins. Acta Obstet Gynecol Scand. 1966. 45:43–52.
18. Tessen JA, Zlatnik FJ. Monoamniotic twins: a retrospective controlled study. Obstet Gynecol. 1991. 77:832–834.
19. Bahtiyar MO, Dulay AT, Weeks BP, Friedman AH, Copel JA. Prevalence of congenital heart defects in monochorionic/diamniotic twin gestations: a systematic literature review. J Ultrasound Med. 2007. 26:1491–1498.
20. McDonald S, Murphy K, Beyene J, Ohlsson A. Perinatal outcomes of in vitro fertilization twins: a systematic review and meta-analyses. Am J Obstet Gynecol. 2005. 193:141–152.
21. Dias T, Mahsud-Dornan S, Bhide A, Papageorghiou AT, Thilaganathan B. Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 2010. 35:201–204.
22. Rodis JF, McIlveen PF, Egan JF, Borgida AF, Turner GW, Campbell WA. Monoamniotic twins: improved perinatal survival with accurate prenatal diagnosis and antenatal fetal surveillance. Am J Obstet Gynecol. 1997. 177:1046–1049.
23. Heyborne KD, Porreco RP, Garite TJ, Phair K, Abril D. Improved perinatal survival of monoamniotic twins with intensive inpatient monitoring. Am J Obstet Gynecol. 2005. 192:96–101.
24. Carr SR, Aronson MP, Coustan DR. Survival rates of monoamniotic twins do not decrease after 30 weeks' gestation. Am J Obstet Gynecol. 1990. 163:719–722.
25. Annan B, Hutson RC. Double survival despite cord entwinement in monoamniotic twins. Case report. Br J Obstet Gynaecol. 1990. 97:950–951.
26. Dubecq F, Dufour P, Vinatier D, Thibault D, Lefebvre C, Tordjeman N, et al. Monoamniotic twin pregnancies. Review of the literature, and a case report with vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 1996. 66:183–186.
27. Myrianthopoulos NC. Congenital malformations in twins: epidemiologic survey. Birth Defects Orig Artic Ser. 1975. 11:1–39.
TOOLS
Similar articles