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Monochorionic Monoamniotic Twins
Priyanka Jha, MBBS; Anne Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Monochorionic monoamniotic twins (MMT)
            • Definitions

              • 2 fetuses in single amniotic sac
                • Single chorion
                • Single amnion
                • Usually single yolk sac (YS)

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Adekola H et al: Spontaneous septostomy in a monochorionic-diamniotic twin gestation. J Clin Ultrasound. 49(1):66-70, 2021
                                    2. Chitrit Y et al: Perinatal mortality and morbidity, timing and route of delivery in monoamniotic twin pregnancies: a retrospective cohort study. Arch Gynecol Obstet. ePub, 2020
                                    3. Gleeson EI et al: Monochorionic monoamniotic twin-twin transfusion syndrome treated with laser ablation. Eur J Obstet Gynecol Reprod Biol. 246:193-4, 2020
                                    4. Murgano D et al: Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 55(3):310-7, 2020
                                    5. Saccone G et al: Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple-pregnancy cohorts. Ultrasound Obstet Gynecol. 55(3):332-8, 2020
                                    6. SMFM Patient Safety and Quality Committee, Society for Maternal-Fetal Medicine et al: SMFM special statement: updated checklists for management of monochorionic twin pregnancy. Am J Obstet Gynecol. 223(5):B16-20, 2020
                                    7. Wataganara T et al: Additional benefits of three-dimensional ultrasound for prenatal assessment of twins. J Perinat Med. 48(2):102-14, 2020
                                    8. Bibbo C et al: Timing of antenatal corticosteroid administration in monoamniotic twins. AJP Rep. 9(2):e153-9, 2019
                                    9. D'Antonio F et al: Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 53(2):166-74, 2019
                                    10. Fenton C et al: The significance of yolk sac number in monoamniotic twins. Fetal Diagn Ther. 46(3):193-9, 2019
                                    11. Glinianaia SV et al: Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000-2013. Ultrasound Obstet Gynecol. 53(2):184-92, 2019
                                    12. Jha P et al: US evaluation of twin pregnancies: importance of chorionicity and amnionicity. Radiographics. 39(7):2146-66, 2019
                                    13. Madsen C et al: Outcomes of monoamniotic twin pregnancies managed primarily in outpatient care-a Danish multicenter study. Acta Obstet Gynecol Scand. 98(4):479-86, 2019
                                    14. MONOMONO Working Group.: Inpatient vs outpatient management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study. Ultrasound Obstet Gynecol. 53(2):175-83, 2019
                                    15. Shields LBE et al: Cloacal anomalies in monoamniotic, monochorionic twins with complete urinary tract obstruction. Urol Int. 103(3):369-71, 2019
                                    16. Gordon BJ et al: Incidental septostomy after laser surgery for twin-twin transfusion syndrome: perinatal outcomes and antenatal management. Fetal Diagn Ther. 44(4):285-90, 2018
                                    17. Greimel P et al: A modified technique for cord transection in monochorionic monoamniotic twin pregnancies. Fetal Diagn Ther. 44(3):236-40, 2018
                                    18. Park SY et al: Prediction of amnionicity using the number of yolk sacs in monochorionic multifetal pregnancy. J Korean Med Sci. 32(12):2016-20, 2017
                                    19. Anselem O et al: Continued pregnancy and vaginal delivery after 32 weeks of gestation for monoamniotic twins. Eur J Obstet Gynecol Reprod Biol. 194:194-8, 2015
                                    20. Bahtiyar MO et al: The North American Fetal Therapy Network consensus statement: prenatal surveillance of uncomplicated monochorionic gestations. Obstet Gynecol. 125(1):118-23, 2015
                                    21. Ishii K: Prenatal diagnosis and management of monoamniotic twins. Curr Opin Obstet Gynecol. 27(2):159-64, 2015
                                    22. Kristiansen MK et al: Perinatal outcome after first-trimester risk assessment in monochorionic and dichorionic twin pregnancies: a population-based register study. BJOG. 122(10):1362-9, 2015
                                    23. Post A et al: Managing monoamniotic twin pregnancies. Clin Obstet Gynecol. 58(3):643-53, 2015
                                    24. Prefumo F et al: The natural history of monoamniotic twin pregnancies: a case series and systematic review of the literature. Prenat Diagn. 35(3):274-80, 2015
                                    25. Shub A et al: Planned early delivery versus expectant management for monoamniotic twins. Cochrane Database Syst Rev. 4:CD008820, 2015
                                    26. Winkler SS et al: The psychosocial impact of inpatient management of monoamniotic twin gestations. J Matern Fetal Neonatal Med. 1-4, 2015
                                    27. Zhao DP et al: Monochorionic placentas with proximate umbilical cord insertions: definition, prevalence and angio-architecture. Placenta. 36(2):221-5, 2015
                                    28. Aurioles-Garibay A et al: Presence of an umbilical artery notch in monochorionic/monoamniotic twins. Fetal Diagn Ther. 36(4):305-11, 2014
                                    29. Peeters SH et al: Fetal surgery in complicated monoamniotic pregnancies: case series and systematic review of the literature. Prenat Diagn. 34(6):586-91, 2014
                                    30. Van Mieghem T et al: Prenatal management of monoamniotic twin pregnancies. Obstet Gynecol. 124(3):498-506, 2014
                                    31. D'Antonio F et al: Crown-rump length discordance and adverse perinatal outcome in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol. 41(6):621-6, 2013
                                    32. Rossi AC et al: Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature. Ultrasound Obstet Gynecol. 41(2):131-5, 2013
                                    33. Morikawa M et al: Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies. Twin Res Hum Genet. 15(4):522-6, 2012
                                    34. Dias T et al: Pregnancy outcome of monochorionic twins: does amnionicity matter? Twin Res Hum Genet;14(6):586-92, 2011
                                    35. Dias T et al: Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 35(2):201-4, 2010
                                    36. Lewi L: Cord entanglement in monoamniotic twins: does it really matter? Ultrasound Obstet Gynecol. 35(2):139-41, 2010
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Monochorionic monoamniotic twins (MMT)
                                              • Definitions

                                                • 2 fetuses in single amniotic sac
                                                  • Single chorion
                                                  • Single amnion
                                                  • Usually single yolk sac (YS)

                                              IMAGING

                                              • General Features

                                                • Ultrasonographic Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Gross Pathologic & Surgical Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Adekola H et al: Spontaneous septostomy in a monochorionic-diamniotic twin gestation. J Clin Ultrasound. 49(1):66-70, 2021
                                                                      2. Chitrit Y et al: Perinatal mortality and morbidity, timing and route of delivery in monoamniotic twin pregnancies: a retrospective cohort study. Arch Gynecol Obstet. ePub, 2020
                                                                      3. Gleeson EI et al: Monochorionic monoamniotic twin-twin transfusion syndrome treated with laser ablation. Eur J Obstet Gynecol Reprod Biol. 246:193-4, 2020
                                                                      4. Murgano D et al: Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 55(3):310-7, 2020
                                                                      5. Saccone G et al: Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple-pregnancy cohorts. Ultrasound Obstet Gynecol. 55(3):332-8, 2020
                                                                      6. SMFM Patient Safety and Quality Committee, Society for Maternal-Fetal Medicine et al: SMFM special statement: updated checklists for management of monochorionic twin pregnancy. Am J Obstet Gynecol. 223(5):B16-20, 2020
                                                                      7. Wataganara T et al: Additional benefits of three-dimensional ultrasound for prenatal assessment of twins. J Perinat Med. 48(2):102-14, 2020
                                                                      8. Bibbo C et al: Timing of antenatal corticosteroid administration in monoamniotic twins. AJP Rep. 9(2):e153-9, 2019
                                                                      9. D'Antonio F et al: Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 53(2):166-74, 2019
                                                                      10. Fenton C et al: The significance of yolk sac number in monoamniotic twins. Fetal Diagn Ther. 46(3):193-9, 2019
                                                                      11. Glinianaia SV et al: Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000-2013. Ultrasound Obstet Gynecol. 53(2):184-92, 2019
                                                                      12. Jha P et al: US evaluation of twin pregnancies: importance of chorionicity and amnionicity. Radiographics. 39(7):2146-66, 2019
                                                                      13. Madsen C et al: Outcomes of monoamniotic twin pregnancies managed primarily in outpatient care-a Danish multicenter study. Acta Obstet Gynecol Scand. 98(4):479-86, 2019
                                                                      14. MONOMONO Working Group.: Inpatient vs outpatient management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study. Ultrasound Obstet Gynecol. 53(2):175-83, 2019
                                                                      15. Shields LBE et al: Cloacal anomalies in monoamniotic, monochorionic twins with complete urinary tract obstruction. Urol Int. 103(3):369-71, 2019
                                                                      16. Gordon BJ et al: Incidental septostomy after laser surgery for twin-twin transfusion syndrome: perinatal outcomes and antenatal management. Fetal Diagn Ther. 44(4):285-90, 2018
                                                                      17. Greimel P et al: A modified technique for cord transection in monochorionic monoamniotic twin pregnancies. Fetal Diagn Ther. 44(3):236-40, 2018
                                                                      18. Park SY et al: Prediction of amnionicity using the number of yolk sacs in monochorionic multifetal pregnancy. J Korean Med Sci. 32(12):2016-20, 2017
                                                                      19. Anselem O et al: Continued pregnancy and vaginal delivery after 32 weeks of gestation for monoamniotic twins. Eur J Obstet Gynecol Reprod Biol. 194:194-8, 2015
                                                                      20. Bahtiyar MO et al: The North American Fetal Therapy Network consensus statement: prenatal surveillance of uncomplicated monochorionic gestations. Obstet Gynecol. 125(1):118-23, 2015
                                                                      21. Ishii K: Prenatal diagnosis and management of monoamniotic twins. Curr Opin Obstet Gynecol. 27(2):159-64, 2015
                                                                      22. Kristiansen MK et al: Perinatal outcome after first-trimester risk assessment in monochorionic and dichorionic twin pregnancies: a population-based register study. BJOG. 122(10):1362-9, 2015
                                                                      23. Post A et al: Managing monoamniotic twin pregnancies. Clin Obstet Gynecol. 58(3):643-53, 2015
                                                                      24. Prefumo F et al: The natural history of monoamniotic twin pregnancies: a case series and systematic review of the literature. Prenat Diagn. 35(3):274-80, 2015
                                                                      25. Shub A et al: Planned early delivery versus expectant management for monoamniotic twins. Cochrane Database Syst Rev. 4:CD008820, 2015
                                                                      26. Winkler SS et al: The psychosocial impact of inpatient management of monoamniotic twin gestations. J Matern Fetal Neonatal Med. 1-4, 2015
                                                                      27. Zhao DP et al: Monochorionic placentas with proximate umbilical cord insertions: definition, prevalence and angio-architecture. Placenta. 36(2):221-5, 2015
                                                                      28. Aurioles-Garibay A et al: Presence of an umbilical artery notch in monochorionic/monoamniotic twins. Fetal Diagn Ther. 36(4):305-11, 2014
                                                                      29. Peeters SH et al: Fetal surgery in complicated monoamniotic pregnancies: case series and systematic review of the literature. Prenat Diagn. 34(6):586-91, 2014
                                                                      30. Van Mieghem T et al: Prenatal management of monoamniotic twin pregnancies. Obstet Gynecol. 124(3):498-506, 2014
                                                                      31. D'Antonio F et al: Crown-rump length discordance and adverse perinatal outcome in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol. 41(6):621-6, 2013
                                                                      32. Rossi AC et al: Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature. Ultrasound Obstet Gynecol. 41(2):131-5, 2013
                                                                      33. Morikawa M et al: Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies. Twin Res Hum Genet. 15(4):522-6, 2012
                                                                      34. Dias T et al: Pregnancy outcome of monochorionic twins: does amnionicity matter? Twin Res Hum Genet;14(6):586-92, 2011
                                                                      35. Dias T et al: Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 35(2):201-4, 2010
                                                                      36. Lewi L: Cord entanglement in monoamniotic twins: does it really matter? Ultrasound Obstet Gynecol. 35(2):139-41, 2010