|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: monoamniotic twinsFrom: art fougner, md (evsono@pipeline.com)Thu Jan 14 11:43:17 1999
hope these references are useful - Am J Obstet Gynecol 1997 Nov;177(5):1046-9 Monoamniotic twins: improved perinatal survival with accurate prenatal diagnosis and antenatal fetal surveillance. Rodis JF, McIlveen PF, Egan JF, Borgida AF, Turner GW, Campbell WA Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, USA. OBJECTIVE: Our goal was to report our 10-year experience with monoamniotic twins and to compare that experience with cases reported in the literature. STUDY DESIGN: Records of all monoamniotic twin pregnancies managed at the University of Connecticut Health Center from March 1986 to August 1996 were reviewed. A MEDLINE search from January 1966 to August 1996 was performed, and each report was screened for accuracy of diagnosis. Only cases with umbilical cord entanglement of nonconjoined like-sex twins, the obstetrician's confirmation at delivery, or pathologic confirmation of monoamniotic placentation were included. Data collected were as follows: birth outcome, gestational age at delivery, birth weight, gender, Apgar scores, hematocrit, cord knotting, and neonatal complications. Cases from the literature were divided into those with prenatal diagnosis and those without. RESULTS: Thirteen monoamniotic pregnancies resulting in 26 infants who were born alive were managed at our center. The average gestational age at diagnosis was 16.3 weeks. All had antenatal fetal surveillance including serial sonograms and nonstress tests. The average gestational age and birth weight at delivery were 32.9 weeks and 1669 gm, respectively. Cord entanglement was noted in all cases, with knotting in 8 of 13. Two pairs of 26 newborns had evidence of twin-twin transfusion syndrome. Eight of 13 monoamniotic pregnancies were delivered because of nonreassuring results of nonstress test, two because of preterm labor, two electively because of lung maturity, and one because of intrauterine growth restriction. Two of the 26 infants died in the neonatal period, one of congenital heart disease and one of sepsis and asphyxia. The MEDLINE search revealed 96 articles with a total of 202 sets of monoamniotic twins. Comparison of cases (13 sets) with the historic control group without prenatal diagnosis (77 sets) showed a 71% reduction in relative risk of perinatal mortality. CONCLUSIONS: With accurate prenatal diagnosis, intensive fetal surveillance, and appropriately timed delivery, perinatal survival of monoamniotic twins is improved; it was 92% in this series. Aust N Z J Obstet Gynaecol 1996 Aug;36(3):309-12 Monoamniotic twin pregnancy and cord entanglement: a clinical dilemma. Ritossa M, O'Loughlin J Department of Obstetrics and Gynaecology, Womens and Childrens Hospital, North Adelaide, South Australia. Monoamniotic twin pregnancies are rare, but are associated with a high risk of perinatal death. The major complications are due to cord entanglement and twin twin transfusion. We were recently faced with the clinical problem of a monoamniotic twin pregnancy complicated by cord entanglement. Fortunately the outcome was favourable with the survival of both twins after delivery by elective Caesarean section at 32 weeks' gestation. Our case as well as some of the controversies in the management of this unpredictable condition are presented. Most authors seem to prefer abdominal delivery upon reaching fetal lung maturity in the case of known monoamniotic twins although this management is not validated by the available studies. Hospital admission for fetal monitoring upon discovery of a cord entanglement at a viable gestation is also advocated. Obstet Gynecol 1995 Aug;86(2):218-22 Monoamniotic and pseudomonoamniotic twins: sonographic diagnosis, detection of cord entanglement, and obstetric management. Aisenbrey GA, Catanzarite VA, Hurley TJ, Spiegel JH, Schrimmer DB, Mendoza A Perinatal Associates of New Mexico, Albuquerque, USA. OBJECTIVE: To assess accuracy of detecting cord entanglement in monoamniotic twins, and to describe perinatal outcomes with aggressive obstetric management. METHODS: Seven nonconjoined monoamniotic twin pregnancies and one pseudomonoamniotic twin pregnancy were diagnosed sonographically and evaluated with serial scans and cardiotocography. In the absence of other indications, patients were delivered by elective cesarean on demonstration of lung maturity at or beyond 32 weeks' gestation. RESULTS: Cord entanglement was diagnosed correctly in four pregnancies, missed in one, and excluded correctly in three. Four pregnancies were delivered after demonstration of pulmonary maturity, three because of premature rupture of membranes or uncontrollable preterm labor, and one because of fetal heart rate abnormality during tocolysis for preterm labor. The mean gestational age at delivery was 33.2 +/- 1.6 weeks, with birth weight 2011 +/- 262 g; all neonates were live-born. Newborn stays averaged 12.0 +/- 5.8 days for the eight neonates delivered electively. CONCLUSION: Monoamniotic twin pregnancies and cord entanglement in such twins were diagnosed reliably by ultrasound. Abnormal tracings prompting cesarean delivery occurred in two of the five pregnancies with cord entanglement. Amniocentesis reflected pulmonary maturity of both twins in all pregnancies so assessed, and delivery after 32 weeks' gestation, with lung maturity, resulted in good perinatal outcomes. Statistical validity of these findings is limited by our small sample size. Am J Obstet Gynecol 1990 Sep;163(3):719-22 Survival rates of monoamniotic twins do not decrease after 30 weeks' gestation. Carr SR, Aronson MP, Coustan DR Women and Infants' Hospital of Rhode Island/Brown University, Providence 02905-2499. A search of pathology records from the years 1967 to 1988 at Women and Infants' Hospital of Rhode Island (138,232 live births) revealed 24 sets of histologically confirmed monoamniotic twins. All records were available for review. Among the 17 sets of monoamniotic twins that reached 30 weeks' gestation with at least one twin still alive, there were no further fetal deaths. The risks of early delivery in these pregnancies appear to outweigh the risk of fetal death as a result of monoamniotic status alone. These data do not show an advantage to early delivery. Obstet Gynecol 1991 Jun;77(6):832-4 Monoamniotic twins: a retrospective controlled study. Tessen JA, Zlatnik FJ Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City. Monoamniotic twins are uncommon but are at high risk (reportedly 50%) for perinatal death, commonly from cord accidents. Until recently the diagnosis of monoamniotic twinning was seldom made before delivery, but modern ultrasound technology permits diagnosis during prenatal care, creating a management dilemma. This is a report of the experience with monoamniotic twins of 20 or more weeks' gestation at the University of Iowa Hospitals from 1961-1989. Twenty monoamniotic twin pregnancies were compared with 40 monochorionic, diamniotic controls regarding antepartum and intrapartum complications. Overall, monoamniotic twins were delivered earlier, were more likely to die in utero, and had lower birth weights than diamniotic twins. When only live-born twins were considered, however, there were no differences in gestational age at delivery, birth weight, or 5-minute Apgar scores. No fetal death occurred after 32 weeks, suggesting that prophylactic preterm delivery may not be indicated in all cases. Labor and vaginal delivery were not associated with an increased risk of fetal death. good luck! Art
At Thu, 14 Jan 1999, jane@seasonedsystems.com wrote:
>
-- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Sun Nov 2 05:15:28 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.