Current antenatal management of monoamniotic twins: a survey of maternal-fetal medicine specialists

Objective: To assess current management of monoamniotic (MA) twins by US maternal-fetal medicine providers. Methods: We conducted a mailed survey to members of the Society for Maternal-Fetal Medicine regarding fetal surveillance practices and preferred gestational age (GA) for elective delivery with respect to MA twins. Results: Responses from 837 (43%) were received with most (83.9%) recommending elective admission for inpatient monitoring, 53.5% favoring 26-28 weeks as earliest GA for admission and 75% performing intermittent fetal monitoring (of these 81% monitored 2-3 times/day). Respondents in practice less than 10 years were less likely to use outpatient management (p < 0.05). Median GA for elective delivery was 34 weeks but was higher for those who favored outpatient management, admitted >28 weeks, and were private practitioners (p < 0.05). Conclusions: Despite a paucity of evidence, most practitioners admit MA to perform daily intermittent fetal monitoring and deliver at 34 weeks. Antenatal management protocols may also influence timing of delivery. Due to their rarity, a national registry may be a better tool to analyze the outcomes of these pregnancies.