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Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review
Thesis (MMed) -- Stellenbosch University, 2022.
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| Language: | en_ZA |
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Stellenbosch : Stellenbosch University
2022
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| _version_ | 1867614097994940416 |
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| access_status_str | Open Access |
| author | Mkoka, Siphelele Augastine |
| author2 | Swart, Hester Alida |
| author_browse | Mkoka, Siphelele Augastine Swart, Hester Alida |
| author_facet | Swart, Hester Alida Mkoka, Siphelele Augastine |
| author_sort | Mkoka, Siphelele Augastine |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MMed) -- Stellenbosch University, 2022. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/126054 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:46:38.139Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/126054 Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review Mkoka, Siphelele Augastine Swart, Hester Alida Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology. Pregnancy -- Complications Monoamniotic twin pregnancies Gestational age Neonatology UCTD Thesis (MMed) -- Stellenbosch University, 2022. ENGLISH ABSTRACT: Background: Monoamniotic twin pregnancies (MATPs) are at high risk of antenatal and perinatal complications including fetal loss. There is still no consensus regarding the optimal management strategies, incorporating antenatal monitoring and the mode and timing of delivery. Aim: Little is known regarding the management and outcomes of MATPs in low-and middle-income countries. We aim to assess and describe the management and shortterm outcomes of MATPs at Tygerberg Hospital (TBH), a South African university hospital and compare it with the available literature. Methods: This retrospective audit includes all MATPs managed from 2011-2020 at TBH. Primary aims were to review the fetal and neonatal outcomes as well as the mode and gestational age (GA) at delivery. Secondary aims included a composite of maternal and perinatal outcomes. Results: The study includes 62 MATPs. Miscarriage rate < 22 weeks GA was 13.1% and the risk of intra-uterine fetal demise (IUFD) was 27.2% of which most of those (73.7%) were double IUFD. Overall live birth rate was 72.5%. The overall perinatal mortality was 12.2% and 6.7% when fetal anomalies (FA) were excluded. The overall survival rate until discharge was 65% of which 56.7% were double survivors and 16.7% single survivors. Neonatal death rate was 5.8% and FA occurred in 27% of all MATPs. There was a birthweight discordance of 10.3 12.2% when considering all fetuses and 6.8% 6.5% in viable fetuses without FA. The average GA at delivery for pregnancies reaching viability without FA was 32 1.9 weeks. Normal vertex delivery occurred in 28% (only non-viable pregnancies) and 62.9% had caesarean sections. Neonatal admission was on average 3 weeks with significant morbidity occurring in 54.5% of the live births. Conclusion: MATPs remain a high-risk group and consensus on management strategies is yet to be reached. This study demonstrates that with increased surveillance and early delivery, the survival rate of MATPs is high, especially once severe FA are excluded. The Fetal Medicine team of TBH remains in support of inpatient care from viability onwards and delivery at 32 weeks GA via caesarean section. Additionally, delivery before 32 weeks must be preceded by fetal preparation with antenatal corticosteroids and magnesium sulphate. AFRIKAANS OPSOMMING: Agtergrond: Monoamniotiese tweeling swangerskappe (MATS) het ‘n verhoogde risiko vir voorgeboorte en perinatale komplikasies, insluitend fetale sterftes. Daar is steeds nie ooreenstemming oor die optimale behandelings-strategieë wat insluit monitering en die metode en tydsberekening vir verlossing nie. Doelwit: Daar is ‘n leemte in kennis oor die hantering en uitkomste van MATS in lae-en-middel-inkomste lande. Ons doel is om die hantering en korttermyn uitkomste van MATS by Tygerberg Hospitaal (TBH), ‘n Suid-Afrikaanse universiteits-hospitaal te ondersoek en te beskryf en dan te vergelyk met aanbevelings in beskikbare literatuur. Metodes Hierdie retrospektiewe oudit sluit alle MATS in wat van 2011-2020 by TBH hanteer is. Primêre uitkomste was om die fetale en neonatale uitkomste na te gaan, asook die metode en gestasionele ouderdom (GO) ten tye van verlossing. Sekondêre uitkomste het ‘n aantal moederlike en perinatale uitkomste ingesluit. Resultate: Die studie sluit 62 MATS in. Die koers van miskrame <22 weke GO was 13.1% and die risiko van intra-uteriene fetale dood (IUFD) was 27.2% van wie meeste gevalle (73.7%) dubbel IUFD was. Die totale lewend-gebore koers was 72.5%. Die totale perinatale mortaliteit was 12.2% en 6.7% wanneer fetale abnormaliteite (FA) uitgesluit is. Die totale oorleweingskoers tot ontslag was 65% waar 56.7% dubbel oorlewings was en 16.7% enkel oorlewings. Die neonatale sterftekoers was 5.8% en FA was teenwoordig in 27% van alle MATS. Daar was ‘n geboortegewig-verskil van 10.312.2% as alle fetusse in ag geneem word en 6.8%6.5% in lewensvatbare fetusse sonder FA. Die gemiddelde GO met verlossing vir swangerskappe wat lewensvatbaarheid bereik het sonder FA was 321.9 weke. Normale skedel verlossings het in 28% plaasgevind (almal nie-lewensvatbare swangerskappe) en 62.9% was deur middel van keisersnitte verlos. Neonatale toelatings was vir ‘n gemiddeld van 3 weke met noemenswaardige morbiditeit in 54.5% van lewendgebore babas. Gevolgtrekkings: MATS bly ‘n hoë-risiko groep en daar is steeds nie eenstemmigheid oor behandelingstratigieë vir hierdie groep nie. Hierdie studie demonstreer dat as daar verhoogde waarneming en vroeë verlossing toegepas word, die oorlewingskoers van MATS hoog is, veral as FA uitgeskakel word. Die Fetale Medisyne Eenheid van TBH ondersteun steeds binne-pasiënt hantering vanaf lewensvatbaarheid en verlossing op 32 weke GO. Daarbenewens moet verlossing voor 32 weke voorafgegaan word met fetale voorbereiding met kortikosteroïdes en magnesium sulfaat. 2022-11-19T12:54:05Z 2023-01-16T12:47:42Z 2022-11-19T12:54:05Z 2023-01-16T12:47:42Z 2022-11 Thesis http://hdl.handle.net/10019.1/126054 en_ZA Stellenbosch University xv, 47 pages application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Pregnancy -- Complications Monoamniotic twin pregnancies Gestational age Neonatology UCTD Mkoka, Siphelele Augastine Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review |
| title | Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review |
| title_full | Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review |
| title_fullStr | Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review |
| title_full_unstemmed | Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review |
| title_short | Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review |
| title_sort | outcomes of monoamniotic twin pregnancies at tygerberg hospital a ten year review |
| topic | Pregnancy -- Complications Monoamniotic twin pregnancies Gestational age Neonatology UCTD |
| url | http://hdl.handle.net/10019.1/126054 |
| work_keys_str_mv | AT mkokasipheleleaugastine outcomesofmonoamniotictwinpregnanciesattygerberghospitalatenyearreview |