First-trimester ultrasound determination of chorionicity in twin pregnancy

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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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

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.11160 ◽

2012 ◽

Vol 39 (5) ◽

pp. 607-608 ◽

Cited By ~ 11

Author(s):

S. L. Corbett ◽

D. Shmorgun

Keyword(s):

Twin Pregnancy ◽

First Trimester ◽

Yolk Sac ◽

Monochorionic Twin ◽

Twin Pregnancies ◽

First Trimester Ultrasound

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First-trimester ultrasound dating of twin pregnancy: are singleton charts reliable?

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.2010.02592.x ◽

2010 ◽

Vol 117 (8) ◽

pp. 979-984 ◽

Cited By ~ 33

Author(s):

T Dias ◽

S Mahsud-Dornan ◽

B Thilaganathan ◽

A Papageorghiou ◽

A Bhide

Keyword(s):

Twin Pregnancy ◽

First Trimester ◽

First Trimester Ultrasound

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Changes in the Ultrasonographical Appearance of Intertwin-Dividing Membrane of Monochorionic Diamniotic Twin Pregnancy

Twin Research and Human Genetics ◽

10.1017/thg.2021.15 ◽

2021 ◽

pp. 1-3

Author(s):

Eri Soga ◽

Takeshi Murakoshi ◽

Shuhei Terada ◽

Hiroko Konno

Keyword(s):

Twin Pregnancy ◽

Ultrasound Image ◽

First Trimester ◽

High Accuracy ◽

Healthy Male ◽

Emergency Cesarean ◽

Ultrasound Findings ◽

Chorionic Membrane ◽

Amniotic Membranes

Abstract Ultrasound determination of chorionicity in the first trimester has a high accuracy, but it is associated with some pitfalls. This report presents changes in ultrasound findings during a monochorionic pregnancy with chorionic membrane folding (CMF). The patient was a 32-year-old woman, gravida 2 para 0. Her transvaginal ultrasonography identified two gestational sacs (GSs) and two embryos at 7 weeks of gestation. At 9 weeks’ gestation, an ultrasound image showed a lambda sign at both sides and the interruption of chorionic membranes, resulting in the diagnosis of a monochorionic diamniotic (MCDA) twin pregnancy with CMF. At 11 weeks’ gestation, an ultrasound image showed a lambda sign at one portion of the septum and a T sign at another portion. This change suggested that the folded chorionic membrane had partially flattened. At 35 weeks’ gestation, an emergency cesarean section was performed. Two healthy male neonates were delivered. Histological placental examination confirmed that the intertwin membrane was composed of two amniotic membranes without a folded chorionic membrane, confirming the diagnosis of a MCDA twin pregnancy. This case presents two important ultrasound chorionicity findings: a monochorionic pregnancy with CMF can show two GSs and a lambda sign and the CMF can flatten or change during the pregnancy.

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First-trimester ultrasound determination of chorionicity in twin gestations using the lambda sign: a systematic review and meta-analysis

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2016.04.023 ◽

2016 ◽

Vol 202 ◽

pp. 66-70 ◽

Cited By ~ 22

Author(s):

G.M. Maruotti ◽

G. Saccone ◽

M. Morlando ◽

P. Martinelli

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

First Trimester ◽

First Trimester Ultrasound

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Monochorionic Monozygotic Twin Pregnancy Complicated with Twin-Twin Transfusion Syndrome Presenting with an Obvious Lambda Sign in the First Trimester

Fetal Diagnosis and Therapy ◽

10.1159/000367969 ◽

2015 ◽

Vol 37 (2) ◽

pp. 154-156 ◽

Cited By ~ 4

Author(s):

Akiko Yamashita ◽

Keisuke Ishii ◽

Nobuhiro Hidaka ◽

Naoto Yonetani ◽

Shusaku Hayashi ◽

...

Keyword(s):

Twin Pregnancy ◽

Dna Typing ◽

First Trimester ◽

Monozygotic Twin ◽

Ultrasound Evaluation ◽

First Trimester Ultrasound

In this report, we present a case of twin-twin transfusion syndrome in the presence of the thick dividing wall of each sac in dichorionic twins. The dichorionic diagnosis was based on the presence of the lambda sign at the first-trimester ultrasound evaluation. In addition to fetoscopic and pathological investigation, DNA typing confirmed that the twin set was monochorionic and monozygotic. This case illustrates that although extremely uncommon, the presence of lambda sign does not exclude monochorionic pregnancy.

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First trimester ultrasound identifies more cases of Down syndrome than second trimester maternal serum screening and is more cost effective

PsycEXTRA Dataset ◽

10.1037/e556492006-009 ◽

2003 ◽

Keyword(s):

Down Syndrome ◽

Cost Effective ◽

First Trimester ◽

Maternal Serum ◽

Second Trimester ◽

Maternal Serum Screening ◽

Serum Screening ◽

First Trimester Ultrasound

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First trimester ultrasound screening for trisomy 21 based on maternal age, fetal nuchal translucency and different combinations of the additional markers nasal bone, tricuspid and ductus venosus flow

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0035-1558776 ◽

2015 ◽

Vol 36 (S 01) ◽

Author(s):

KO Kagan ◽

M Hoopmann ◽

P Wagner ◽

H Abele

Keyword(s):

Trisomy 21 ◽

Maternal Age ◽

Nasal Bone ◽

First Trimester ◽

Nuchal Translucency ◽

Ductus Venosus ◽

Ultrasound Screening ◽

First Trimester Ultrasound

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FRACTIONAL DETERMINATIONS OF URINARY 17-KETOSTEROIDS IN HYPEREMESIS GRAVIDARUM

Acta Endocrinologica ◽

10.1530/acta.0.0410123 ◽

1962 ◽

Vol 41 (1) ◽

pp. 123-128 ◽

Cited By ~ 6

Author(s):

Pentti A. Järvinen ◽

Sykkö Pesonen ◽

Pirkko Väänänen

Keyword(s):

Hyperemesis Gravidarum ◽

First Trimester ◽

Control Group ◽

Before And After ◽

Daily Urine ◽

First Trimester Of Pregnancy ◽

The Difference

ABSTRACT The fractional determination of 17-ketosteroids in the daily urine was performed in nine cases of hyperemesis gravidarum and in four control cases, in the first trimester of pregnancy both before and after corticotrophin administration. The excretion of total 17-KS is similar in the two groups. Only in the hyperemesis group does the excretion of total 17-KS increase significantly after corticotrophin administration. The fractional determination reveals no difference between the two groups of patients with regard to the values of the fractions U (unidentified 17-KS), A (androsterone) and Rest (11-oxygenated 17-KS). The excretion of dehydroepiandrosterone is significantly higher in the hyperemesis group than in the control group. The excretion of androstanolone seems to be lower in the hyperemesis group than in the control group, but the difference is not statistically significant. The differences in the correlation between dehydroepiandrosterone and androstanolone in the two groups is significant. The high excretion of dehydroepiandrosterone and low excretion of androstanolone in cases of hyperemesis gravidarum is a sign of adrenal dysfunction.

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