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Am J Perinatol 2022; 39(03): 243-251
DOI: 10.1055/s-0040-1714420
Review Article

Neonatal Morbidity of Monoamniotic Twin Pregnancies: A Systematic Review and Meta-analysis

Danilo Buca   *
1   Department of Obstetrics and Gynecology, Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy
,
Daniele Di Mascio    *
2   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
,
Asma Khalil
3   Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom
4   Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom
,
Ganesh Acharya
5   Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
6   Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
,
Tim Van Mieghem
7   Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
,
Karien Hack
8   Department of Obstetrics and Gynecology, Gelre Hospitals Apeldoorn, The Netherlands
,
Masaharu Murata
9   Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan
,
Olivia Anselem
10   Maternité Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel-Dieu, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
,
Alice D'Amico
1   Department of Obstetrics and Gynecology, Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy
,
Ludovico Muzii
2   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
,
Marco Liberati
1   Department of Obstetrics and Gynecology, Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy
,
Luigi Nappi
11   Department of Obstetrics and Gynecology, Fetal Medicine and Cardiology Unit, University of Foggia, Foggia, Italy
,
Francesco D'Antonio
11   Department of Obstetrics and Gynecology, Fetal Medicine and Cardiology Unit, University of Foggia, Foggia, Italy
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Funding None.
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Abstract

Objective This study was aimed to report the incidence of neonatal morbidity in monochorionic monoamniotic (MCMA) twin pregnancies according to gestational age at birth and type of management adopted (inpatient or outpatient).

Study Design Medline and Embase databases were searched. Inclusion criteria were nonanomalous MCMA twins. The primary outcome was a composite score of neonatal morbidity, defined as the occurrence of at least one of the following outcomes: respiratory morbidity, overall neurological morbidity, severe neurological morbidity, and infectious morbidity, necrotizing enterocolitis at different gestational age windows (24–30, 31–32, 33–34, and 35–36 weeks). Secondary outcomes were the individual components of the primary outcome and admission to neonatal intensive care unit (NICU). Subanalysis according to the type of surveillance strategy (inpatient compared with outpatient) was also performed. Random effect meta-analyses were used to analyze the data.

Results A total of 14 studies including 685 MCMA twin pregnancies without fetal anomalies were included. At 24 to 30, 31 to 32, 33 to 34, and 35 to 36 weeks of gestation, the rate of composite morbidity was 75.4, 65.5, 37.6, and 18.5%, respectively, the rate of respiratory morbidity was 74.2, 59.1, 35.5, and 12.2%, respectively, while overall neurological morbidity occurred in 15.3, 10.2, 4.3, and 0% of the cases, respectively. Infectious morbidity complicated 13, 4.2, 3.1, and 0% of newborns while 92.1, 81.6, 58.7, and 0% of cases required admission to NICU. Morbidity in pregnancies delivered between 35 and 36 weeks of gestation was affected by the very small sample size of cases included. When comparing the occurrence of overall morbidity according to the type of management (inpatient or outpatient), there was no difference between the two surveillance strategies (p = 0.114).

Conclusion MCMA pregnancies are at high risk of composite neonatal morbidity, mainly respiratory morbidity that gradually decreases with increasing gestational age at delivery with a significant reduction for pregnancies delivered between 33 and 34 weeks. We found no difference in the occurrence of neonatal morbidity between pregnancies managed as inpatient or outpatient.

Key Points

  • MCMA pregnancies are at high risk of composite neonatal morbidity, mainly respiratory morbidity.

  • Neonatal morbidity gradually decreases with increasing GA at delivery, mostly between 33 and 34 weeks.

  • There is no difference in the occurrence of neonatal morbidity between in- or outpatient management.

Keywords

morbidity - monoamniotic - monochorionic - MCMA - twins - twin pregnancy

* These authors share first authorship.


Supplementary Material



Publication History

Received: 25 April 2020

Accepted: 18 June 2020

Article published online:
28 July 2020

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