Monoamniotic twins occur in approximately in 1% of monozygotic twins. The reported incidence varies from 1:1650- 1:93734 live births. Perinatal mortality of twin pregnancy is high, ranging from 28%-70%. The principal causes are umbilical cord entanglement and accidents, congenital anomalies, preterm delivery, intrauterine growth restriction and placental anastomotic events. Congenital anomalies occur with an increased frequency in Monoamniotic twins, are related to acardia, anencephaly and congenital cardiac defects. Accurate recognition of monoamnionicity is central to management strategies. Serial ultrasound every 2 weekly are done to assess fetal growth, amniotic fluid volume, and geography of the dual umbilical cord. The timing of the delivery in Monoamniotic twins is balance between the risk of preterm birth and the risk of intrauterine death. Recommended timing of the delivery varies between 32-35 weeks gestation. The majority of units uses caesarean birth as the preferred delivery mode for Monoamniotic after consideration of course of steroids for fetal lung maturity.
We report here two cases of Monoamniotic twins, which are managed by Fetal medicine unit in our hospital. Both cases had caesarean section at 32 weeks of gestation with successful pregnancy outcome.
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