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Monoamniotic twin pregnancy
Author(s) -
Dias Tiran,
Thilaganathan Basky,
Bhide Amar
Publication year - 2012
Publication title -
the obstetrician and gynaecologist
Language(s) - English
Resource type - Journals
eISSN - 1744-4667
pISSN - 1467-2561
DOI - 10.1111/j.1744-4667.2012.00092.x
Subject(s) - medicine , obstetrics , incidence (geometry) , pregnancy , umbilical cord , twin pregnancy , etiology , gestation , caesarean delivery , caesarean section , physics , anatomy , psychiatry , optics , biology , genetics
Key content Monoamniotic twins are believed to account for 1–5% of all monozygotic conceptions, with an estimated annual incidence of 30–150 pregnancies in the UK. High perinatal loss rates in monoamniotic twins have been attributed mainly to umbilical cord entanglement, inter‐twin transfusion syndrome, discordant fetal abnormality or fetal growth restriction. Management of monoamniotic twin pregnancy is aimed at preventing antenatal fetal death and optimising timing of delivery. Despite the paucity of robust data on the incidence and causes of perinatal loss, elective delivery at 32–34 weeks of gestation has been proposed. Most obstetric units use caesarean birth as the preferred mode of delivery for monoamniotic twins to prevent intrapartum cord complications.Learning objectives To understand the aetiology, incidence and diagnosis of monoamnionicity. To be able to identify the type and prevalence of complications in monoamniotic twins. To be aware of the current evidence on the antenatal management and optimal timing of delivery of monoamniotic twin pregnancy.Ethical issues Can we justify elective preterm delivery and its subsequent complications without a robust evidence base demonstrating a reduction in perinatal morbidity and mortality?