Cord entanglement and perinatal outcome in monoamniotic twin pregnancies

dc.contributor.authorDias, T.en_US
dc.contributor.authorMahsud-Dornan, S.en_US
dc.contributor.authorBhide, A.en_US
dc.contributor.authorPapageorghiou, A. T.en_US
dc.contributor.authorThilaganathan, B.en_US
dc.creator.corporateauthorInternational Society of Ultrasound in Obstetrics and Gynecologyen_US
dc.date.accessioned2014-10-29T09:28:31Z
dc.date.available2014-10-29T09:28:31Z
dc.date.issued2010en_US
dc.descriptionIndexed in MEDLINE
dc.description.abstractOBJECTIVES: To assess the prevalence of cord entanglement and perinatal outcome in a large series of monoamniotic twin pregnancies and to review the recent literature on similar published large series. METHODS: Prospective observational study of all prenatally detected cases of monoamniotic twin pregnancies during an 8-year period in a tertiary fetal medicine unit. A Medline database review for publications since 2000 containing five or more cases of monoamniotic pregnancies that showed data on cord entanglement and perinatal outcome was also undertaken. RESULTS: A total of 32 monoamniotic pregnancies were diagnosed during the study period, including three conjoined twins, seven pregnancies with twin reversed arterial perfusion (TRAP) syndrome, three surgical pregnancy interruptions for discordant fetal abnormality and one miscarriage before 16 weeks' gestation. The remaining 18 monoamniotic pregnancies were included in the study analysis. All monoamniotic pregnancies were complicated with antenatal cord entanglement diagnosed by B-mode and color Doppler ultrasound. There were 34 live births and a double intrauterine death diagnosed at 19 + 2 weeks' gestation. There were two late neonatal deaths, one from congenital complete heart block and the other after surgery for transposition of the great arteries. The overall perinatal loss rate was 11.1% after 16 weeks and 5.9% after 20 weeks' gestation. The cumulative rates of cord entanglement and perinatal mortality in the reviewed literature were 74% and 21%, respectively. CONCLUSIONS: Umbilical cord entanglement is present in all monoamniotic twins when it is systematically evaluated by ultrasound and color Doppler. Perinatal mortality in monoamniotic twins is mainly a consequence of conjoined twins, TRAP, discordant anomaly and spontaneous miscarriage before 20 weeks' gestation. Expectantly managed monoamniotic twins after 20 weeks have a very good prognosis despite the finding of cord entanglement. The practice of elective very preterm delivery or other interventions to prevent cord accidents in monoamniotic twins should be re-evaluated.en_US
dc.identifier.citationUltrasound in Obstetrics and Gynecology. 2010; 35(2): pp.201-4en_US
dc.identifier.departmentObstetrics and Gynaecologyen_US
dc.identifier.issn0960-7692 (Print)en_US
dc.identifier.issn1469-0705 (Electronic)en_US
dc.identifier.urihttp://repository.kln.ac.lk/handle/123456789/1980
dc.publisherWileyen_US
dc.subjectPregnancy, Twinen_US
dc.titleCord entanglement and perinatal outcome in monoamniotic twin pregnanciesen_US
dc.typeReviewen_US

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