Monochorionic monoamniotic twin pregnancy. Three cases presented and review of the literature
DOI:
https://doi.org/10.18597/rcog.93Keywords:
Twins, monozygotic twins, multiple pregnancy, twin pregnancyAbstract
Objective: To report cases of monochorionic monoamniotic twin pregnancy with cord entanglement, and conduct a review of the literature regarding the prognosis of this type of gestation, prenatal follow-up and management interventions through to delivery.
Materials and methods: We report 3 cases that presented to Hospital Universitario del Valle, Cali, Colombia, a level III referral center in Southwestern Colombia that provides healthcare services to pregnant women with a high obstetric risk. We conducted a search in the literature in the Medline/ Pubmed database published in Spanish and English between January 1990 and May 2013. The terms used were “twins”, “monozygotic twins”, “multiple pregnancy”, “twin pregnancy”. Review articles, case reports and cross-sectional studies were included.
Results: Overall, 23 articles were reviewed, including 5 review articles, 7 case reports and 11 cross-sectional studies. Information on mortality rates, pre-natal assessment, follow-up, management of complications, time and mode of birth in monoamniotic twins is controversial.
Conclusion: Monochorial monoamniotic twin pregnancy is an infrequent event. This condition is associated with multiple obstetric complications, including fetal demise associated with umbilical cord accidents (entanglement). The goal of prenatal care is to prevent fetal death, hence the suggestion of continuous testing for fetal wellbeing. Termination of pregnancy has been proposed at week 34 of gestation through cesarean section after steroid administration.
Author Biographies
Juliana Rodríguez-Castillo
Julián Delgado-Gutiérrez
Juan Carlos Quintero-Mejía
Tatiana Peña-Ramírez
Sandra García-Novillo
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