Yolk sac number does not predict reliably amnionicity in monochorionic twin pregnancies: a case of a monochorionic monoamniotic twin pregnancy with two distinct yolk sacs on early first-trimester ultrasound

AbstractOBJECTIVE. The purpose of this study was to evaluate the relationship between the yolk sacs separated or not separated by septum and chorionicity twin pregnancies scanned early in the first trimester, and the relation between size and morphologic features of the yolk sac and the outcome of twin pregnancies.RESULTS. In all 38 sets of twins two yolk sacs were identified. During the first trimester of a dichorionic twin pregnancy, the yolk sacs were always separated by a septum and not separated (“Eight” sign) in monochorionic twin pregnancy. In five cases, one of yolk sac was abnormally large (> 8mm) and had thin wall. Four of the five mothers spontaneously aborted during the next 2-3 weeks. In one case of monochorionic twin ectopic pregnancy two yolk sacs were seen normally.CONCLUSION. The sonographic identification of yolk sacs in multiple pregnancies allows an early and efficient recognition of presence and chorionicity of twin pregnancy, both in intra – and extrauterine. Identification of abnormal yolk sac or yolk sacs suggests death of one or all embryos.

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When diamniotic twins suddenly become monoamniotic twins: spontaneous septostomy of the dividing membrane

BMJ Case Reports ◽

10.1136/bcr-2021-243513 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243513

Author(s):

Angela Vidal ◽

Cristina Nastasia ◽

Markus Hodel ◽

Joachim Kohl

Keyword(s):

Twin Pregnancy ◽

Rare Condition ◽

First Trimester ◽

Sonographic Diagnosis ◽

Sudden Failure ◽

Reliable Diagnosis ◽

Accepted Standard ◽

Perinatal Management ◽

Twin Pregnancies ◽

First Trimester Ultrasound

In twin pregnancies, amnionicity and chorionicity are crucial as they strongly determine prenatal and perinatal management. First trimester ultrasound allows a highly reliable diagnosis of amnionicity and chorionicity, making it an internationally accepted standard in antenatal care. However, in rare cases, amnionicity can change from diamniotic to monoamniotic throughout pregnancy, substantially impacting perinatal management. We report the case of a confirmed monochorionic diamniotic twin pregnancy with a diagnosis of spontaneous septostomy of the dividing membrane (SSDM) at 28 weeks of gestation, resulting in a pseudomonoamniotic pregnancy. Even though SSDM is a rare condition and its sonographic diagnosis might be challenging, it should be considered if, in a known diamniotic pregnancy, there is a sudden failure to visualise the intertwin membrane truly separating both twins.

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sFlt-1, Not PlGF, Is Related to Twin Gestation Choronicity in the First and Third Trimesters of Pregnancy

Diagnostics ◽

10.3390/diagnostics11071181 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1181

Author(s):

Szymon Kozłowski ◽

Anna Stelmaszczyk-Emmel ◽

Iwona Szymusik ◽

Aleksandra Saletra-Bielińska ◽

Robert Brawura-Biskupski-Samaha ◽

...

Keyword(s):

Twin Pregnancy ◽

Prospective Observational Study ◽

First Trimester ◽

Placental Growth Factor ◽

Serum Concentrations ◽

Third Trimester ◽

Monochorionic Twin ◽

The Third ◽

Angiogenic Biomarkers ◽

Twin Pregnancies

Background: Preeclampsia occurs more often in dichorionic than in monochorionic twin pregnancy. We hypothesize that serum concentrations of biomarkers: placental growth factor (PlGF), serum soluble fms-like tyrosine kinase-1 (sFlt-1), and endoglin (Eng) differ between monochorionic and dichorionic twin pregnancies. Methods: A prospective observational study including 43 monochorionic and 36 dichorionic twin gestation was conducted. Blood samples were collected twice from all participants: between 11 + 0 and 13 + 6 and between 32 + 0 and 34 + 0 weeks of gestation. PlGF, sFlt-1 and Eng were measured using immnunoenzymatic assays. Results: We found a significantly higher concentration of sFlt-1 in dichorionic in comparison to monochorionic pregnancies in both the first and third trimesters. PlGF and sEng levels did not differ between mono- and dichorionic gestation in both study periods. sFlt-1 level was related to twin gestation chorionicity, while PlGF expression was not. PlGF, sFlt-1 and sEng concentrations increased significantly during gestation and were much higher in the third trimester compared to the values measured in the first trimester. Conclusions: Angiogenic biomarkers expression differ between dichorionic and monochorionic twin pregnancy. The sFlt-1 level is related to chorionicity of a twin gestation.

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EP21.27: The role of first trimester ultrasound markers in early prediction of specific complications in monochorionic twin pregnancies

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.21580 ◽

2019 ◽

Vol 54 (S1) ◽

pp. 376-376

Author(s):

K. Kostyukov ◽

A.N. Sencha

Keyword(s):

First Trimester ◽

Early Prediction ◽

Monochorionic Twin ◽

Twin Pregnancies ◽

First Trimester Ultrasound

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The Incidence of Dichorionic Diamniotic Twin Pregnancy After Single Blastocyst Embryo Transfer and Zygosity: 8 Years of Single-Center Experience

Twin Research and Human Genetics ◽

10.1017/thg.2020.5 ◽

2020 ◽

Vol 23 (1) ◽

pp. 51-54 ◽

Cited By ~ 1

Author(s):

Hiroko Konno ◽

Takeshi Murakoshi ◽

Kiyonori Miura ◽

Hideaki Masuzaki

Keyword(s):

Embryo Transfer ◽

Twin Pregnancy ◽

Hormone Replacement ◽

First Trimester ◽

Frozen Embryo Transfer ◽

The Other ◽

Placental Pathology ◽

Monochorionic Twin ◽

Single Center Experience ◽

Twin Pregnancies

AbstractDichorionic diamniotic (DCDA) twin pregnancies after single blastocyst embryo transfer have been reported recently, although a blastocyst ovum is generally believed to divide into monochorionic twin pregnancy. We investigated the incidence of DCDA twin pregnancy after single blastocyst embryo transfer and their zygosity. This prospective cohort study included 655 consecutive twin pregnancies that were managed from 2006 to 2014 at our institution. Chorionicity and amnionicity were determined using first-trimester ultrasonography and/or placental pathology. Zygosity was analyzed if the cases were DCDA twins after single blastocyst embryo transfer. Among 655 twin pregnancies, there were 348 DCDA cases, 295 monochorionic diamniotic (MCDA) cases and 12 monochorionic monoamniotic cases. Single blastocyst embryo transfer was performed in 43 cases. Six out of the 43 (14%) cases involved DCDA twin pregnancies and the other 37 cases involved MCDA twin pregnancies. Three DCDA twins born after single blastocyst embryo transfer, wherein frozen embryo transfer (FET) was performed in the natural cycle, were dizygotic, and the other three cases, wherein FET with hormone replacement therapy was performed, were monozygotic. DCDA twin pregnancy occurred in 14% (7% for monozygotic and 7% for dizygotic) of twin pregnancies after single blastocyst embryo transfer cases.

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First-trimester ultrasound examination and the outcome of monochorionic twin pregnancies

Prenatal Diagnosis ◽

10.1002/pd.1802 ◽

2007 ◽

Vol 27 (10) ◽

pp. 922-925 ◽

Cited By ~ 48

Author(s):

A. El Kateb ◽

B. Nasr ◽

M. Nassar ◽

J. P. Bernard ◽

Y. Ville

Keyword(s):

Ultrasound Examination ◽

First Trimester ◽

Monochorionic Twin ◽

Twin Pregnancies ◽

First Trimester Ultrasound

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Yearly Changes in Stillbirth Rates of Zygotic Twins in Japan, 1975-1994

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000000349 ◽

1998 ◽

Vol 47 (1) ◽

pp. 19-30 ◽

Cited By ~ 5

Author(s):

Y. Imaizumi ◽

K. Nonaka

Keyword(s):

Medical Care ◽

Twin Pregnancy ◽

Japanese Women ◽

Stillbirth Rate ◽

Monochorionic Twin ◽

Mz Twins ◽

Twin Pregnancies

AbstractThe stillbirth rates decreased to 2/3 for MZ male twins, 1/2 for MZ female twins, and under 1/2 for DZ twins for both sexes during the 19-year period from 1975 in Japan. The stillbirth rate was significantly higher in MZ males than MZ females in each year, whereas stillbirth rates of DZ twins for both sexes indicated similar values during that period. After 1986, stillbirth rates were more than 2 times higher in MZ twins than in singletons and in DZ twins. The higher stillbirth rate of MZ twins as opposed to DZ twins could be related to monochorionic twin pairs in MZ twins. The stillbirth rate decreased more drastically in twins for both zygosities than in singleton births during the 34-year period from 1960. However, declining rates of stillbirths may be attributed to medical care during twin pregnancies. Recommendation of an optimum day to give birth for twin pregnancy is 37-38 weeks for Japanese women.

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