title: Prenatal management of monoamniotic twin pregnancies.
abstract: OBJECTIVE
  To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic twin pregnancies.
  
  
  METHODS
  Obstetric and perinatal outcomes were retrospectively retrieved for 193 monoamniotic twin pregnancies. Fetal and neonatal outcomes were compared between fetuses followed in an inpatient setting and those undergoing intensive outpatient follow-up from 26 to 28 weeks of gestation until planned cesarean delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal complications.
  
  
  RESULTS
  Fetal deaths occurred in 18.1% of fetuses (70/386). Two hundred ninety-five neonates from 153 pregnancies were born alive after 23 weeks of gestation. There were 17 neonatal deaths (5.8%), five of whom had major congenital anomalies. The prospective risk of a nonrespiratory neonatal complication was lower than the prospective risk of fetal death after 32 4/7 weeks of gestation (95% confidence interval 32 0/7-33 4/7). The incidence of death or a nonrespiratory neonatal complication was not significantly different between fetuses managed as outpatients (14/106 [13.2%]) or inpatients (15/142 [10.5%]; P=.55). Our statistical power to detect a difference in outcomes between these groups was low.
  
  
  CONCLUSIONS
  The in utero risk of a monoamniotic twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal surveillance is instituted after 26-28 weeks of gestation and delivery takes place at approximately 33 weeks of gestation, the risk of fetal or neonatal death is low, no matter the surveillance setting.
  
  
  METHODS
  II.
authors.affiliation: Fetal Medicine Unit, Department of Obstetrics and Gynaecology, and the Neonatal Intensive Care Unit, Department of Paediatrics, Mount Sinai Hospital, and the Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, University of Toronto, Toronto, Ontario, Canada; the Department of Woman and Baby, University Medical Centre, Utrecht, The Netherlands; the Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; the Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria; the Ultrasound and Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire Vaudois and Swiss Laser Group, Lausanne, Switzerland; Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey; and the Department of Obstetrics and Gynaecology, Inselspital University of Bern and Swiss Laser Group, Bern, Switzerland.
authors.forename: Tim
authors.initials: T
authors.lastname: Van Mieghem
authors.forename: Roel
authors.initials: R
authors.lastname: De Heus
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Lewi
authors.forename: Philipp
authors.initials: P
authors.lastname: Klaritsch
authors.forename: Martina
authors.initials: M
authors.lastname: Kollmann
authors.forename: David
authors.initials: D
authors.lastname: Baud
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vial
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.forename: Angela C
authors.initials: AC
authors.lastname: Ranzini
authors.forename: Lauren
authors.initials: L
authors.lastname: Mason
authors.forename: Luigi
authors.initials: L
authors.lastname: Raio
authors.forename: Regine
authors.initials: R
authors.lastname: Lachat
authors.forename: Jon
authors.initials: J
authors.lastname: Barrett
authors.forename: Vesal
authors.initials: V
authors.lastname: Khorsand
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
mesh_terms: D000650:Amnion; D002985:Clinical Protocols; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000401:mortality; D036861:Delivery, Obstetric / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D046689:Fetal Mortality; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014430:Twins, Monozygotic / Q000706:statistics & numerical data*; D016216:Ultrasonography, Prenatal / Q000379:methods