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35: Monoamniotic twin pregnancy: continuous inpatient electronic fetal monitoring (CIEFM)- an impossible goal?

      Objective

      To determine the feasibility and utility of CIEFM in monoamniotic twin pregnancies.

      Study Design

      A retrospective cohort study of monoamniotic twins delivered at a single institution from 2000 to 2009 was performed. All subjects were hospitalized, received CIEFM, and planned to deliver electively via cesarean section at 34 weeks gestational age (GA). The entire electronic fetal heart tracing was reviewed for each patient and the percentage of time that 0, 1, and 2 fetuses were successfully monitored was recorded. Each subject′s hospitalization was stratified by gestational age (<27 weeks, 27-30 weeks, and >30 weeks) and the percentage of time of successful monitoring was compared across gestational age.

      Results

      17 twin pairs were studied. Admission for CIEFM was at 27 +/− 3 weeks GA (mean +/− SD). A total of 10, 402 hours of CIEFM recordings were analyzed. Average length of stay was 31.7 +/− 15.6 days (mean +/− SD). Successful monitoring of both fetuses occurred 50.4% +/− 14.5% of the time of total hospitalization. Increasing GA was associated with a significant increase in the percentage of time that both fetuses were monitored (38.2% at <27 weeks; 50.2% at 27-30 weeks; 55.8% at>30 weeks; p<0.01). 7/17 (40%) subjects were delivered emergently <34 weeks GA for non-reassuring CIEFM. GA at delivery in this group was 31.5 +/− 2 weeks GA. 5/17 (30%) went into labor <34 weeks GA; and 5/17 (30%) were delivered as planned at 34 weeks GA. All patients delivered via cesarean section. There were no fetal deaths in our population.

      Conclusion

      Successful CIEFM improves with increasing GA. CIEFM is attainable 50% of the time. Despite this finding, non-reassuring CIEFM precipitated delivery in 40% of cases. We believe that the limitations of CIEFM do not negate its role in the management of monoamniotic twins, but invite further research in optimal strategies for intermittent inpatient EFM.