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Am J Perinatol 2026; 43(02): 209-221
DOI: 10.1055/a-2600-0585
Original Article

Monitoring Methods for Monoamniotic Twin Pregnancies: Multicenter Retrospective Study of 149 Cases

Autor*innen

  • Norbert Winer 

    1   Department of Gynecology and Obstetrics, University Hospital, Nantes, France
    2   Nantes Université, CHU Nantes, INRAE, UMR 1280, PhAN, Nantes, France

  • Louise Cariou De Vergie

    1   Department of Gynecology and Obstetrics, University Hospital, Nantes, France

  • Laure Maillet Dumas

    1   Department of Gynecology and Obstetrics, University Hospital, Nantes, France

  • Thibault Thubert

    1   Department of Gynecology and Obstetrics, University Hospital, Nantes, France
    2   Nantes Université, CHU Nantes, INRAE, UMR 1280, PhAN, Nantes, France
    3   Department of Neonatology, Nantes University Hospital, Nantes, France
    4   Laboratoire Motricité, Interactions, Performances (MIP), UR 4334, UFR STAPS, Nantes Université, Nantes, France

  • Emilie Misbert

    1   Department of Gynecology and Obstetrics, University Hospital, Nantes, France

  • Cyril Flamant

    3   Department of Neonatology, Nantes University Hospital, Nantes, France

  • Vincent Dochez

    1   Department of Gynecology and Obstetrics, University Hospital, Nantes, France
    2   Nantes Université, CHU Nantes, INRAE, UMR 1280, PhAN, Nantes, France
    3   Department of Neonatology, Nantes University Hospital, Nantes, France
    4   Laboratoire Motricité, Interactions, Performances (MIP), UR 4334, UFR STAPS, Nantes Université, Nantes, France

  • Bernard Branger

    1   Department of Gynecology and Obstetrics, University Hospital, Nantes, France
    • the French Monoamniotic Group

Funding None.
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Abstract

Objective

Monoamniotic twins is rare and associated with a high rate of perinatal morbidity and mortality. In addition to the common risks, more specific complications, cord entanglement in particular, worsen their prognosis. The literature about the optimal gestational age for birth and mode of delivery is still conflicting. To evaluate strategy used in France for the prenatal and intrapartum management monoamniotic twin pregnancies in France.

Study Design

This retrospective multicenter study retrieved the strategies and outcomes for 149 monoamniotic twin pregnancies from 10 university hospitals in France over an 18-year period. Two methods of managing the follow-up methods of these pregnancies with a propensity score were distinguished: follow-up in a participating maternity unit as an inpatient or outpatient. Two populations were analyzed: inpatients and outpatients were compared among all pregnancies and fetuses from 260/7 to 346/7 weeks of gestation (n = 92). All pregnancies and fetuses not born after 350/7 weeks of gestation (n = 57) were analyzed separately. The primary endpoints were intrauterine and perinatal mortality rates.

Results

Perinatal mortality didn't differ between the 38 inpatient and 54 outpatient pregnancies (15.8 vs. 14.8%). The same was true for all fetuses and newborns with 7 deaths out of 76 (9.2% for inpatients) and 10 deaths out of 108 (9.2% for outpatients, p = 0.99). Finally, 57 pregnancies (33%) continued past 35 weeks. One death in utero was observed at 20 weeks and only one other at 35 weeks (1.5%).

Conclusion

This study shows no differences between inpatient and outpatient management and suggests that some perinatal centers envision continuing these pregnancies past 35 weeks. Vaginal delivery is not strictly contraindicated, although cesarean delivery is safe and most often recommended.

Key Points

  • Monoamniotic twin pregnancies are rare with an elevated risk of fetal and neonatal mortality.

  • To monitor the risk factors closely, they can be managed either as inpatients or outpatients.

  • Delivery, most often by cesarean, around 32 to 34 weeks, is recommended because of the rare but avoidable and thus especially distressing in utero deaths.

  • Controversy persists, nonetheless, about management (inpatient or outpatient), optimal gestation age for delivery, and mode of delivery

Keywords

monoamniotic twin pregnancies - monochorionic monoamniotic - inpatients - outpatients - cord entanglement

Authors' Contributions

L.C.V., L.M.D., B.B., and N.W. performed the literature search, conceived the study, participated in the project design, obtained the funding, drafted the manuscript, edited, and approved the final manuscript. V.D., T.T., E.M., and C.F. approved the study, participated in the project design, read, revised, and approved the final manuscript. B.B. performed the statistical analyses and revised and approved the final manuscript. N.W. reports that he is a consultant for Roche Diagnostic France.


* French Monoamniotic Group:


• Prof. O. Sibony and Prof. Thomas Schmitz, Robert Debré Hospital Maternity Ward, Paris, France.


• Prof. V. Houfflin-Debarge and Dr. P. Vaast, Lille University Hospital Center Maternity Ward.


• Prof. Y. Ville, Prof. L Salomon, Dr. G. Chalouhi, and Dr. C. Vellupilai, Necker Hospital Maternity Ward, Paris, France.


• Prof. P. Rozenberg, Poissy-Saint Germain en Laye Intercommunal Hospital Maternity Ward.


• Prof. Goffinet and Dr. O. Anselem, Port-Royal Maternity Hospital, Paris, France.


• Prof. Riethmuller, Besançon Regional University Hospital Center Maternity Ward.


• Prof. A. Benachi, Antoine Béclère Hospital Maternity Ward, Clamart, France.


• Dr. F. Biquard, Dr. P. Gillard, and Pr. Descamps, Angers University Hospital Center Maternity Ward.


• Prof. F. Pierre and Dr. M. Dugué-Marechaud, Poitiers University Hospital Center Maternity Ward.




Publikationsverlauf

Eingereicht: 26. Mai 2024

Angenommen: 05. Mai 2025

Artikel online veröffentlicht:
28. Mai 2025

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