Abstract
Monoamniotic twins account for around one per 25,000 pregnancies. They are associated with high rates of perinatal morbidity and mortality. The literature about the optimal gestational age for birth and mode of delivery is conflicting. This study is to evaluate in France prenatal monitoring strategies and analyze with our practice the optimal timing and mode of delivery for monoamniotic twin pregnancies Retrospective multicenter study reviewing obstetric and perinatal outcomes for 221 monoamniotic twin pregnancies from 10 university obstetric departments in France in 1998-2015. Gestational age at delivery and risks of fetal death and neonatal morbidity were compared between women monitored as inpatients and as outpatients. Perinatal outcomes were also compared according to mode of delivery for women who gave birth at or after 34 weeks of gestation. Overall perinatal mortality (from 22 weeks to day 8 postnatal) was 18.4% and corrected perinatal mortality (after exclusion of lethal fetal malformations) 13.2%. Mean gestational age at birth did not differ significantly between fetuses managed as inpatients (33 weeks) and outpatients (34 weeks; P=0.8), nor did the incidence of intrauterine death and perinatal outcomes (7/62, 6.4% and 12/139, 8.6%, P=0.5). After 34 weeks, one third (34%) of the women gave birth vaginally. Most outcomes (umbilical artery pH, intrauterine fetal death, and neonatal death) did not differ significantly between vaginal and cesarean deliveries, although the rate of Apgar scores <7 and admission to neonatal intensive care unit (49.2% vs. 73.3%, P< .0002) were higher in the cesarean group. Outpatient management and continuation of monoamniotic pregnancies beyond 34 weeks of gestation are both reasonable options with optimal surveillance. Although cesareans seem to be recommended most frequently, vaginal delivery is not strictly contraindicated.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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