Perinatal mortality and morbidity, timing and route of delivery in monoamniotic twin pregnancies: a retrospective cohort
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MATERNAL-FETAL MEDICINE
Perinatal mortality and morbidity, timing and route of delivery in monoamniotic twin pregnancies: a retrospective cohort study Yvon Chitrit1 · Diane Korb1,2 · Cecile Morin1,3 · Thomas Schmitz1,2 · Jean‑François Oury1,4 · Olivier Sibony1,4 Received: 20 January 2020 / Accepted: 31 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Monoamniotic twin pregnancies are at high risk of perinatal complications and fetal loss. The objective of this study is to describe the management and outcomes of monoamniotic twin pregnancies in a French university obstetrics department. Methods Retrospective review of all consecutive monoamniotic twin pregnancies managed between 1992 and 2018 in a level-3 university hospital maternity unit. Antenatal variables, gestational age and other neonatal characteristics at delivery, mode of delivery, and its reason were recorded, together with outcomes, including a composite adverse neonatal outcome. Results Overall, 46 monoamniotic twin pregnancies (92 fetuses) were identified during the study period. Among them, 27 fetal losses and 2 early neonatal deaths were reported. Congenital abnormalities accounted for 33.3% of the 27 fetal losses, and unexpected fetal deaths for 29.6%. Among the 37 women who gave birth to 65 live infants at 23 or more weeks of gestation, 17 had cesarean and 19 vaginal deliveries. Overall and composite adverse neonatal outcomes did not differ significantly for the 33 children born vaginally and the 31 by cesarean deliveries. The prospective risk of intrauterine death in all 92 fetuses reached its nadir of 1.8% at 336/7 weeks. Conclusion This series confirms the still high risk of fetal and neonatal death of these twins and shows that congenital abnormalities but also unexpected fetal deaths account for the majority of pre- and postnatal mortality. Our data suggest that vaginal delivery of monoamniotic twins is safe and that delivery for uncomplicated monoamniotic twins should be considered around 33 weeks of gestation, but not later than 35 weeks. Keywords Monoamniotic twin pregnancies · Perinatal mortality · Fetal losses · Congenital abnormalities · Intrauterine death
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00404-020-05782-1) contains supplementary material, which is available to authorized users. * Yvon Chitrit [email protected] 1
Department of Gynecology‑Obstetrics, Assistance PubliqueHôpitaux de Paris, Robert Debré Hospital, 48, Bd Sérurier, 75935 Paris Cedex 19, France
2
Epidemiology and Statistics Research Center/CRESS, University of Paris, INSERM, INRA, 75004 Paris, France
3
Université de Paris, INSERM U1141, 75019 Paris, France
4
University of Paris, Paris, France
Monoamniotic twin pregnancy is a rare event, occurring in about 1–2% of monozygotic twin pregnancies and comprising about 5% of monochorionic pregnancies [1–3]. Monoamniotic twins are at high risk of perinatal complications and fetal loss,
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