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Monochorionic Monoamniotic Twins
Anne M. Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Monochorionic monoamniotic twins (MMT)
          • Definitions

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

          IMAGING

          • General Features

            • CT Findings

              • 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. 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
                                    2. Booker W et al: Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile. J Ultrasound Med. 34(11):2071-5, 2015
                                    3. Ishii K: Prenatal diagnosis and management of monoamniotic twins. Curr Opin Obstet Gynecol. 27(2):159-64, 2015
                                    4. 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
                                    5. Post A et al: Managing Monoamniotic Twin Pregnancies. Clin Obstet Gynecol. 58(3):643-53, 2015
                                    6. 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
                                    7. Shub A et al: Planned early delivery versus expectant management for monoamniotic twins. Cochrane Database Syst Rev. 4:CD008820, 2015
                                    8. Winkler SS et al: The psychosocial impact of inpatient management of monoamniotic twin gestations. J Matern Fetal Neonatal Med. 1-4, 2015
                                    9. Zhao DP et al: Monochorionic placentas with proximate umbilical cord insertions: definition, prevalence and angio-architecture. Placenta. 36(2):221-5, 2015
                                    10. Aurioles-Garibay A et al: Presence of an umbilical artery notch in monochorionic/monoamniotic twins. Fetal Diagn Ther. 36(4):305-11, 2014
                                    11. 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
                                    12. Van Mieghem T et al: Prenatal management of monoamniotic twin pregnancies. Obstet Gynecol. 124(3):498-506, 2014
                                    13. Bhide A: Re: impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature. A. C. Rossi and F. Prefumo. Ultrasound Obstet Gynecol 2013; 41: 131-135. Ultrasound Obstet Gynecol. 41(2):129, 2013
                                    14. 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
                                    15. Murata M et al: Perinatal outcome and clinical features of monochorionic monoamniotic twin gestation. J Obstet Gynaecol Res. 39(5):922-5, 2013
                                    16. 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
                                    17. Morikawa M et al: Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies. Twin Res Hum Genet. 15(4):522-6, 2012
                                    18. Dias T, Contro E, Thilaganathan B, et al: Pregnancy outcome of monochorionic twins: does amnionicity matter? Twin Res Hum Genet 2011;14(6):586-592.
                                    19. Dias T et al: Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 35(2):201-4, 2010
                                    20. Lewi L: Cord entanglement in monoamniotic twins: does it really matter? Ultrasound Obstet Gynecol. 35(2):139-41, 2010
                                    21. Aston KI et al: Monozygotic twinning associated with assisted reproductive technologies: a review. Reproduction. 136(4):377-86, 2008
                                    22. Cordero L et al: Monochorionic monoamniotic twins: neonatal outcome. J Perinatol. 26(3):170-5, 2006
                                    23. Pasquini L et al: High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation. Ultrasound Obstet Gynecol. 28(5):681-7, 2006
                                    24. Perez-Brayfield MR et al: Monoamniotic twin discordant for bilateral renal agenesis with normal pulmonary function. Urology. 64(3):589, 2004
                                    25. Roqué H et al: Perinatal outcomes in monoamniotic gestations. J Matern Fetal Neonatal Med. 13(6):414-21, 2003
                                    26. Umur A et al: Monoamniotic-versus diamniotic-monochorionic twin placentas: anastomoses and twin-twin transfusion syndrome. Am J Obstet Gynecol. 189(5):1325-9, 2003
                                    27. Sherer DM et al: Diagnosis of umbilical cord entanglement of monoamniotic twins by first-trimester color Doppler imaging. J Ultrasound Med. 21(11):1307-9, 2002
                                    28. Sebire NJ et al: First trimester diagnosis of monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 16(3):223-5, 2000
                                    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

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Monochorionic monoamniotic twins (MMT)
                                            • Definitions

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

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • 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. 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
                                                                      2. Booker W et al: Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile. J Ultrasound Med. 34(11):2071-5, 2015
                                                                      3. Ishii K: Prenatal diagnosis and management of monoamniotic twins. Curr Opin Obstet Gynecol. 27(2):159-64, 2015
                                                                      4. 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
                                                                      5. Post A et al: Managing Monoamniotic Twin Pregnancies. Clin Obstet Gynecol. 58(3):643-53, 2015
                                                                      6. 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
                                                                      7. Shub A et al: Planned early delivery versus expectant management for monoamniotic twins. Cochrane Database Syst Rev. 4:CD008820, 2015
                                                                      8. Winkler SS et al: The psychosocial impact of inpatient management of monoamniotic twin gestations. J Matern Fetal Neonatal Med. 1-4, 2015
                                                                      9. Zhao DP et al: Monochorionic placentas with proximate umbilical cord insertions: definition, prevalence and angio-architecture. Placenta. 36(2):221-5, 2015
                                                                      10. Aurioles-Garibay A et al: Presence of an umbilical artery notch in monochorionic/monoamniotic twins. Fetal Diagn Ther. 36(4):305-11, 2014
                                                                      11. 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
                                                                      12. Van Mieghem T et al: Prenatal management of monoamniotic twin pregnancies. Obstet Gynecol. 124(3):498-506, 2014
                                                                      13. Bhide A: Re: impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature. A. C. Rossi and F. Prefumo. Ultrasound Obstet Gynecol 2013; 41: 131-135. Ultrasound Obstet Gynecol. 41(2):129, 2013
                                                                      14. 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
                                                                      15. Murata M et al: Perinatal outcome and clinical features of monochorionic monoamniotic twin gestation. J Obstet Gynaecol Res. 39(5):922-5, 2013
                                                                      16. 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
                                                                      17. Morikawa M et al: Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies. Twin Res Hum Genet. 15(4):522-6, 2012
                                                                      18. Dias T, Contro E, Thilaganathan B, et al: Pregnancy outcome of monochorionic twins: does amnionicity matter? Twin Res Hum Genet 2011;14(6):586-592.
                                                                      19. Dias T et al: Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 35(2):201-4, 2010
                                                                      20. Lewi L: Cord entanglement in monoamniotic twins: does it really matter? Ultrasound Obstet Gynecol. 35(2):139-41, 2010
                                                                      21. Aston KI et al: Monozygotic twinning associated with assisted reproductive technologies: a review. Reproduction. 136(4):377-86, 2008
                                                                      22. Cordero L et al: Monochorionic monoamniotic twins: neonatal outcome. J Perinatol. 26(3):170-5, 2006
                                                                      23. Pasquini L et al: High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks' gestation. Ultrasound Obstet Gynecol. 28(5):681-7, 2006
                                                                      24. Perez-Brayfield MR et al: Monoamniotic twin discordant for bilateral renal agenesis with normal pulmonary function. Urology. 64(3):589, 2004
                                                                      25. Roqué H et al: Perinatal outcomes in monoamniotic gestations. J Matern Fetal Neonatal Med. 13(6):414-21, 2003
                                                                      26. Umur A et al: Monoamniotic-versus diamniotic-monochorionic twin placentas: anastomoses and twin-twin transfusion syndrome. Am J Obstet Gynecol. 189(5):1325-9, 2003
                                                                      27. Sherer DM et al: Diagnosis of umbilical cord entanglement of monoamniotic twins by first-trimester color Doppler imaging. J Ultrasound Med. 21(11):1307-9, 2002
                                                                      28. Sebire NJ et al: First trimester diagnosis of monoamniotic twin pregnancies. Ultrasound Obstet Gynecol. 16(3):223-5, 2000