Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000–2013

• Published in: Ultrasound in obstetrics & gynecology Vol. 53; no. 2; pp. 184 - 192
• Main Authors: Glinianaia, S. V., Rankin, J., Khalil, A., Binder, J., Waring, G., Sturgiss, S. N., Thilaganathan, B., Hannon, T.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.02.2019; Wiley Subscription Services, Inc
• Subjects: Adult; antenatal surveillance; Aquatic birds; Birth; Cesarean section; Cesarean Section - statistics & numerical data; Cohort Studies; Collaboration; Data processing; England - epidemiology; Female; Fetal Monitoring - methods; Fetal Mortality; Fetuses; Gestation; Gestational Age; Health risk assessment; Humans; Infant; Infant, Newborn; Live Birth - epidemiology; Male; monochorionic monoamniotic twins; Mortality; Northern Survey of Twin and Multiple Pregnancy (NorSTAMP); Perinatal Mortality; Population Surveillance; Pregnancy; Pregnancy, Twin - statistics & numerical data; Premature Birth - mortality; Prenatal Care - methods; Prevalence; STORK collaboration; Twins; Twins, Monozygotic - statistics & numerical data; Ultrasonography, Prenatal; Young Adult; England; United Kingdom > UK; STORK collaboration; antenatal surveillance; Northern Survey of Twin and Multiple Pregnancy (NorSTAMP); perinatal mortality; monochorionic monoamniotic twins
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.19114

ABSTRACT Objectives To determine the prevalence of monochorionic monoamniotic (MCMA) twin pregnancy and to describe perinatal outcome and clinical management of these pregnancies. Methods In this multicenter cohort study, the prevalence of MCMA twinning was estimated using population‐based data on MCMA twin pregnancies, collected between 2000 and 2013 from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) maternity units. Pregnancy outcome at < 24 weeks' gestation, antenatal parameters and perinatal outcome (from ≥ 24 weeks to the first 28 days of age) were analyzed using combined data on pregnancies confirmed to be MCMA from NorSTAMP and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort for 2000–2013. Results The estimated total prevalence of MCMA twin pregnancies in the North of England region was 8.2 per 1000 twin pregnancies (59/7170), and the birth prevalence was 0.08 per 1000 pregnancies overall (singleton and multiple). Using combined data from NorSTAMP and STORK, the rate of fetal death (at < 24 weeks' gestation), including terminations of pregnancy and selective feticide, was 31.8% (54/170); the overall perinatal mortality rate was 14.7% (17/116), ranging from 69.2% at < 30 weeks to 4.5% at ≥ 33 weeks' gestation. MCMA twins that survived in utero beyond 24 weeks were delivered, usually by Cesarean section, at a median of 33 (interquartile range, 32–34) weeks of gestation. Conclusions In MCMA twins surviving beyond 24 weeks of gestation, there was a higher survival rate compared with in previous decades, presumably due to early diagnosis, close surveillance and elective birth around 32–34 weeks of gestation. High perinatal mortality at early gestations was attributed mainly to extreme prematurity due to preterm spontaneous labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.