Browsing by Author "Mkoka, Siphelele Augastine"

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    Outcomes of monoamniotic twin pregnancies at Tygerberg Hospital : a ten-year review
    (Stellenbosch : Stellenbosch University, 2022-11) Mkoka, Siphelele Augastine; Swart, Hester Alida; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    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.