Current approaches to managing monochorionic monoamniotic multiple pregnancy

DOI

https://dx.doi.org/10.18565/aig.2022.2.12-19

Mikhailov A.V., Romanovsky A.N., Volchenkova V.E., Kashtanova T.A., Kuznetsov A.A., Shlykova A.V., Kyanksep I.V., Saveleva A.A.
1) Maternity Hospital No. 17, Saint Petersburg, Russia; 2) Department of Obstetrics, Gynecology, and Reproductology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia; 3) S.N. Davydov Department of Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, Saint Petersburg, Russia; 4) Department of Obstetrics, Gynecology and Reproductology, St. Petersburg University, Saint Petersburg, Russia; 5) D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Saint Petersburg, Russia

This paper reviews current provisions on the features of management of monoamniotic twin pregnancy. It describes diagnostic ultrasound criteria for monoamniotic twins and considers main complications of monoamniotic multiple pregnancy, such as congenital developmental anomalies, including conjoined twin syndrome, umbilical cord entanglement, discordant malformations, as well as specific complications of monochorionic twins, such as twin-to-twin transfusion syndrome, anemia-polycythemia sequence, and twin reversed arterial perfusion syndrome. The paper presents the current principles of antenatal correction by fetal surgical techniques. It considers in detail the debatable problems of antenatal follow-up of monoamniotic twin pregnancy, as well as approaches to management tactics and timing of delivery. Monoamniotic twins are extremely high-risk pregnancies that require careful follow-up in order to diagnose and correct possible complications in a timely manner. At the same time, there is nowadays no optimal approach to the follow-up protocol for monoamniotic twins in the second half of pregnancy, to the organization of its outpatient and/or inpatient follow-up, as well as the choice of the optimal delivery time in the uncomplicated course of this pregnancy, which makes it possible to minimize both antenatal losses and neonatal morbidity and mortality.
Conclusion: It is necessary to organize multicenter, preferably randomized trials for establishment of an optimal follow-up protocol in the second half of pregnancy and time of delivery of monoamniotic twins.

monochorionic twins

umbilical cord entanglement

twin-to-twin transfusion syndrome

conjoined twins

discordant malformations

Full text (in Russian)

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Received 21.10.2021

Accepted 24.12.2021

Anton V. Mikhailov, Dr. Med. Sci., Director and Chief of the Maternity Hospital No. 17, Lesnozavodskaya str. 4-1, St. Petersburg, 192174, Russia; Professor of the Department of Obstetrics, Gynecology and Reproduction, Pavlov First Saint Petersburg State Medical University, L'va Tolstogo str., 6-8, St. Petersburg, 197022, Russia; Professor of the Department of Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov, 47, Piskarevskiy Ave., St. Petersburg, 195067, Russia; General Researcher, Ott Institute of Obstetrics, Gynecology and Reproductology, Mendeleevskaya line 3, St. Petersburg, 199034, Russia, mav080960@gmail.com
Artem N. Romanovsky, PhD, obstetrician-gynecologist, ultrasound diagnostician, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia;
Associate Professor of the Department of Obstetrics, Gynecology and Reproductology, St. Petersburg State University, 8а, 21-st Line, St. Petersburg, 199004, Russia.
Veronika E. Volchenkova, obstetrician-gynecologist, ultrasound diagnostician, Maternity Hospital No. 17, Lesnozavodskaya str. 4-1, St. Petersburg, 192174, Russia;
postgraduate of the Department of Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov,
47, Piskarevskiy Ave., St. Petersburg, 195067, Russia.
Tatiana A. Kashtanova, obstetrician-gynecologist, Head of Prenatal Diagnostics Department, Maternity Hospital No. 17,
4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia.
Alexandr A. Kuznetsov, PhD, obstetrician-gynecologist, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia; assistant of the Department
of Obstetrics, Gynecology and Reproduction, Pavlov First Saint Petersburg State Medical University, 6-8, L'va Tolstogo str., St. Petersburg, 197022, Russia.
Anna V. Shlykova, PhD, obstetrician-gynecologist, ultrasound diagnostician, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia.
Inna V. Kyanksep, obstetrician-gynecologist, ultrasound diagnostician, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia.
Anna A. Saveleva, doctor of ultrasound and radiology, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia.
Corresponding author: Anton V. Mikhailov, mav080960@gmail.com

Authors’ contributions: Mikhailov A.V. – manuscript editing and revision; Romanovsky A.N., Volchenkova V.E. – literature data collection, analysis, and generalization; writing the text of the article; preparation of the manuscript; Kashtanova T.A., Kuznetsov A.A., Shlykova A.V., Kyanksep I.V. – literature data collection, analysis, and generalization; Saveleva A.A. – literature data collection.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The article has been prepared for publication without sponsorship.
For citation: Mikhailov A.V., Romanovsky A.N., Volchenkova V.E., Kashtanova T.A., Kuznetsov A.A., Shlykova A.V., Kyanksep I.V., Saveleva A.A. Current approaches to managing monochorionic monoamniotic multiple pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 2: 12-19 (in Russian)
https://dx.doi.org/10.18565/aig.2022.2.12-19

Current approaches to managing monochorionic monoamniotic multiple pregnancy

Mikhailov A.V., Romanovsky A.N., Volchenkova V.E., Kashtanova T.A., Kuznetsov A.A., Shlykova A.V., Kyanksep I.V., Saveleva A.A.

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