title: The psychosocial impact of inpatient management of monoamniotic  twin gestations.
abstract: OBJECTIVE
  Monoamniotic twins require unique considerations in clinical management that challenge both clinicians and patients. The aim of this study was to assess the psychosocial impact of inpatient antepartum versus outpatient management for these patients.
  
  
  METHODS
  Women with a history of a monoamniotic twin pregnancy between 2002 and 2012 were identified through a social media group and invited to participate in an original survey regarding their clinical management and psychological well-being during gestation. Results between patients managed with inpatient versus outpatient protocols were compared using the Fisher exact test.
  
  
  RESULTS
  Participants (n = 197) were multinational. Planned inpatient management after 23 weeks gestation was reported in 76.2% of respondents. Participants in both groups endorsed persistent feelings of hopelessness or despair related to their pregnancies (42.4% of inpatients versus 24.1% of outpatients, p = 0.089). Relationship strain between participants and their partners was similar in both the groups. Participants in the outpatient group were more likely to report feelings of guilt related to their infrequent monitoring (p = 0.01). Patient satisfaction with care was higher in the inpatient group.
  
  
  CONCLUSIONS
  Inpatient management did not significantly increase measures of psychosocial stress as compared to outpatient management. Participants in the outpatient group reported feelings of guilt about their infrequent monitoring. Our findings provide increased understanding of the patient experience in these rare and challenging clinical circumstances.
authors: Stuart S
authors: SS
authors: Winkler
authors: Margaux N
authors: MN
authors: Mustian
authors: Heather L
authors: HL
authors: Mertz
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005323:Fetal Monitoring / Q000523:psychology*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000523:psychology*; D011795:Surveys and Questionnaires