Diagnosis and management of a monochorionic/monoamniotic twin gestation discordant for fetal anomalies.

Monoamniotic twinning is rare and associated with fetal mortality as high as 13-32% (1). In pregnancies discordant for fetal anomalies, mortality is as high as 43% (2.3). Currently, the optimal management and timing of delivery is not clearly defined. A 28-year-old presented with a monochorionic/monoamniotic twin gestation with unexplained ascites, ventriculomegaly, and pericardial effusion of Twin B. She was admitted at 24 weeks for intensive fetal surveillance and sulindac therapy. Planned Cesarean delivery was performed at 32 weeks gestation. A favorable neonatal outcome was achieved. Aggressive inpatient surveillance and intentional preterm delivery may result in favorable outcomes in monochorionic/monoamniotic twin gestations.