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Perinatal Outcome of Monoamniotic Twin Pregnancies

Hack, Karien E. MD, PhD; Derks, Jan B. MD, PhD; Schaap, Arty H. MD, PhD; Lopriore, Enrico MD, PhD; Elias, Sjoerd G. MD, PhD; Arabin, Birgit MD, PhD; Eggink, Alex J. MD, PhD; Sollie, Krystyna M. MD, PhD; Mol, Ben Willem J. MD, PhD; Duvekot, Hans J. MD, PhD; Willekes, Christine MD, PhD; Go, Attie T. MD, PhD; Koopman-Esseboom, Corine MD, PhD; Vandenbussche, Frank P. MD, PhD; Visser, Gerard H. MD, PhD

doi: 10.1097/AOG.0b013e318195bd57
Original Research

OBJECTIVE: To study perinatal mortality and neonatal morbidity in a large cohort of monoamniotic twin pregnancies with special emphasis to the gestational age-specific mortality.

METHODS: The study included monoamniotic twin pregnancies delivered in 10 perinatal centers in the Netherlands between January 2000 and December 2007.

RESULTS: A total of 98 monoamniotic pregnancies were included. The perinatal mortality rate (20 weeks of gestation through 28 days of life) was 19%; after exclusion of fetuses with lethal anomalies, the rate was 17%. After 32 weeks of gestation, only two pregnancies were complicated by perinatal mortality (4%). The incidence of twin–twin transfusion syndrome was 6%. The incidence of congenital heart anomalies and cerebral injury was 4% and 5%, respectively.

CONCLUSION: The current incidence of perinatal mortality in monoamniotic twins is considerably lower than in previous decades, but it is still high and occurs throughout pregnancy.


Perinatal mortality in a series of 98 monoamniotic twins was high (19%) and occurred throughout pregnancy but was considerably lower than in previous decades.

From the 1Department of Obstetrics, 2Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, 3Department of Obstetrics, Academic Medical Center, Amsterdam, 4Department of Neonatology, 5Department of Obstetrics, Leiden University Medical Center, Leiden, 6Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 7Department of Obstetrics, Isala Clinics, Zwolle, 8Department of Obstetrics, Radboud University Nijmegen Medical Center, Nijmegen, 9Department of Obstetrics, University Medical Center Groningen, Groningen, 10Department of Obstetrics, Maxima Medical Center, Veldhoven, 11Department of Obstetrics, Erasmus Medical Center, Rotterdam, 12Department of Obstetrics, University Hospital Maastricht, Maastricht, and 13Department of Obstetrics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.

Corresponding author: Dr. K. E. A. Hack, Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, PO Box 85090, 3508 AB Utrecht, the Netherlands; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.