Monoamniotic Twin Gestation

Question 1

Describe ultrasound features characteristic for a monoamniotic twin gestation.

Answer 1

One placenta
No dividing membrane
Two distinct arterial waveform patterns on pulsed-wave Doppler

Question 2

How do you counsel a patient about the pregnancy risks of a monoamniotic twin gestation?

Answer 2

Cord entanglement
Locked twin syndrome TTTS
Congenital malformations

Question 3

How do you manage a monoamniotic twin gestation?

Answer 3

Offer early inpatient management (beginning at 24–28 weeks of gestation) with daily fetal surveillance with regular assessment of fetal growth

Question 4

When do you recommend delivery for a monoamniotic twin gestation?

Answer 4

32-34 weeks by cesearean

Question 5

How do you manage cotwin demise with a monoamniotic twin gestation?

Answer 5

Consider delaying delivery to allow administration of steroids and magnesium sulphate. Delivery by 28 weeks gestation may be reasonable