Monoamniotic twins: improved perinatal survival with accurate prenatal diagnosis and antenatal fetal surveillance

Survival rates of monoamniotic twins may be significantly improved with early diagnosis, intense monitoring of the fetal heart rate, and judiciously timed cesarean delivery. Monoamniotic twins, sharing a single amniotic sac, are a rare occurrence. Thirteen monoamniotic twins diagnosed in early pregnancy were meticulously supervised. Eight sets of twins were delivered in response to an abnormal fetal heart rate. The survival rate of the closely monitored infants was 92%, compared to a 66% survival rate seen in historical accounts of 77 monoamniotic twins undiagnosed before birth.