Monoamniotic twin pregnancies: antenatal management and perinatal results of 19 consecutive cases.
OBJECTIVE
To describe the obstetric management and perinatal outcome of antenatally diagnosed monoamniotic twin pregnancies (MATP) in a tertiary level maternity unit.


METHODS
Port-Royal Maternity Hospital, Paris, France.


METHODS
MATP that progressed beyond 22 weeks seen from 1993 to 2001.


METHODS
A retrospective chart review of all twin pregnancies. Diagnosis of MATP was made by ultrasonography and confirmed by placental pathology.


METHODS
Perinatal mortality.


RESULTS
Among the 1242 twins pregnancies delivered during the study period, 19 were monoamniotic. Four fetuses (10% of all births) had malformations. Perinatal mortality was high (n= 12, 32%) because of fetal deaths (nine cases) and very preterm births (three neonatal deaths). No fetal deaths occurred after 29 weeks. Of the 15 women with at least one live fetus before labour, 6 gave birth by vaginal delivery (40%). No obstetric accidents occurred during vaginal deliveries.


CONCLUSIONS
Perinatal mortality of MATP is still very high, even with accurate, early antenatal diagnosis, intensified surveillance and delivery provided in a tertiary level hospital. The main causes of perinatal deaths are cord accidents in utero, congenital anomalies and very preterm births.
Demaria
Fabien
F
Department of Obstetrics and Gynecology, Maternity Port-Royal, Cochin-Saint Vincent-de-Paul hospital, University Paris V, 123 Bd de Port-Royal, 75014 Paris, France.
Goffinet
François
F
Kayem
Gilles
G
Tsatsaris
Vassilis
V
Hessabi
Madieh
M
Cabrol
Dominique
D
D000328:Adult; D000650:Amnion; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D010298:Parity; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal