MONOAMNIOTIC AND PSEUDOMONOAMNIOTIC TWINS - SONOGRAPHIC DIAGNOSIS, DETECTION OF CORD ENTANGLEMENT, AND OBSTETRIC MANAGEMENT

Objective: To assess accuracy of detecting cord entanglement in monoam niotic twins, and to describe perinatal outcomes with aggressive obste tric management.Methods: Seven nonconjoined monoamniotic twin pregnanc ies and one pseudomonoamniotic twin pregnancy were diagnosed sonograph ically and evaluated with serial scans and cardiotocography. In the ab sence of other indications, patients were delivered by elective cesare an on demonstration of lung maturity at or beyond 32 weeks' gestation. Results: Cord entanglement was diagnosed correctly in four pregnancie s, missed in one, and excluded correctly in three. Four pregnancies we re delivered after demonstration of pulmonary maturity, three because of premature rupture of membranes or uncontrollable preterm labor, and one because of fetal heart rate abnormality during tocolysis for pret erm labor. The mean gestational age at delivery was 33.2 +/- 1.6 weeks , with birth weight 2011 +/- 262 g; all neonates were live-born. Newbo rn stays averaged 12.0 +/- 5.8 days for the eight neonates delivered e lectively. Conclusion: Monoamniotic twin pregnancies and cord entangle ment in such twins were diagnosed reliably by ultrasound. Abnormal tra cings prompting cesarean delivery occurred in two of the five pregnanc ies with cord entanglement. Amniocentesis reflected pulmonary maturity of both twins in all pregnancies so assessed, and delivery after 32 w eeks' gestation, with lung maturity, resulted in good perinatal outcom es. Statistical validity of these findings is limited by our small sam ple size.