One per cent of identical twins lie in the same sac, so that they almost all develop cord entanglement in the first trimester . Their high perinatal mortality rate of up to 30—50% is attributed to cord accidents both at delivery and in the last half of pregnancy . Perinatal mortality has fallen in recent series to 10—25% due to elective preterm delivery, mandatory Caesarean section and intensive fetal monitoring [55,56]. Prophylactic maternal sulindac therapy to reduce fetal urine output and thus amniotic fluid volume has been successfully used in over 20 cases in our centre to split the twins' excessive movements through relative oligohydramnios and thus reduce the risk of cord tautening .
Monoamniotic placenta are characterized by a high frequency of large artery to artery anastomoses, which explains why they rarely get TTTS and also why single intrauterine death frequently progresses to double fetal death.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.