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Saturday, August 23, 2014
Trailers (92): Management of monoamniotic twin pregnancies

Van Mieghem et al. Prenatal management of monoamniotic twin pregnancies

Why should you read about this topic?

Where is the equipoise between stillbirth risk and preterm delivery consequences for monoamniotic twins?

What were the authors trying to do?

To evaluate antenatal surveillance strategies and derive the optimal time for elective delivery of monoamniotic twin pregnancies

Who participated and in what setting?

Women (N=193) with monoamniotic twin pregnancies (excluding conjoined twins and TRAP sequence pregnancies) at 8 university hospitals in Europe and North America between 2003 and 2012

What was the study design?

Retrospective chart review

What were the main outcome measures?

Fetal death and a composite neonatal morbidity (non-respiratory neonatal complications or death)

What were the results?

Risk of fetal death is greater than the risk of non-respiratory neonatal morbidity at or after 32½ weeks. No difference in outcomes was seen in outpatient vs. inpatient comparisons

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths:  confirmation of amnionicity by pathology; large number of monoamniotic pregnancies.  Weaknesses: retrospective study; inadequate power to compare inpatient with outpatient management

What does the study contribute for your practice?

Information helpful for counseling patients about risks of adverse outcomes

About the Author

William C. Dodson, MD
William C. Dodson, MD, is Professor of Obstetrics and Gynecology and Director of the Division of Reproductive Endocrinology and Infertility at Penn State College of Medicine. He completed his fellowship in reproductive endocrinology at Duke University. His research and clinical areas of focus include treatment of infertility, especially ovulation induction. He was previously on the Editorial Board of Obstetrics & Gynecology and has served as the Consultant Web Editor for Obstetrics & Gynecology since 2008.