Monoamniotic twin pregnancy: continuous inpatient electronic fetal monitoring-an impossible goal?

Objective: We sought to determine the effectiveness of continuous fetal monitoring in monoamniotic twins and assess the percentage of successful monitoring across gestation.

Study design: This was a single-center retrospective cohort analysis of monoamniotic twins. Each subject's entire electronic fetal heart tracing was reviewed. The primary outcome measure was the percentage of time that 0, 1, and 2 fetuses were successfully monitored. To compare the effectiveness of monitoring across gestation, these data were stratified by gestational age (<27, 27-30, and >30 weeks).

Results: A total of 10,402 hours of fetal monitoring were reviewed for 17 monoamniotic twin pairs. Successful monitoring of 0, 1, and 2 fetuses occurred 21.2%, 27.1%, and 51.6% of the time, respectively. Successful monitoring of both fetuses was positively correlated with gestational age (<27 weeks 37%; 27-30 weeks 51%; >30 weeks 57%; P < .007).

Conclusion: Successful monitoring of both fetuses occurred 51.6% of the time. Continuous monitoring efficiency improved with advancing gestational age.