scholarly journals Ultrasound surveillance in twin pregnancy: An update for practitioners

Ultrasound ◽  
2018 ◽  
Vol 26 (4) ◽  
pp. 193-205 ◽  
Author(s):  
R Townsend ◽  
A Khalil
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Twin Pregnancy ◽  
First Trimester ◽  
Evidence Based ◽  
Multiple Pregnancies ◽  
Arterial Perfusion ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion ◽  
Ultrasound Surveillance

Ultrasound has revolutionised the management of multiple pregnancies and their complications. Increasing frequency of twin pregnancies mandates familiarity of all clinicians with the relevant pathologies and evidence-based surveillance and management protocols for their care. In this review, we summarise the latest evidence relating to ultrasound surveillance of twin pregnancies including first trimester assessment and screening, growth surveillance and the detection and management of the complications of monochorionic pregnancies including twin-to-twin-transfusion syndrome, selective fetal growth restriction, twin reversed arterial perfusion sequence and conjoined twinning.

scholarly journals Yolk Sacs in Twin Pregnancy

1998 ◽  
Vol 47 (3-4) ◽  
pp. 177-181 ◽  
Author(s):  
W. Malinowski
Keyword(s):  
Ectopic Pregnancy ◽  
Twin Pregnancy ◽  
First Trimester ◽  
Yolk Sac ◽  
Thin Wall ◽  
Multiple Pregnancies ◽  
Monochorionic Twin ◽  
The Relationship ◽  
Twin Pregnancies ◽  
Efficient Recognition

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.

scholarly journals Congenital Malformations Associated With a Single Umbilical Artery in Twin Pregnancies

2015 ◽  
Vol 18 (5) ◽  
pp. 595-600 ◽  
Author(s):  
Sarah E. Mitchell ◽  
Karen Reidy ◽  
Fabricio Da Silva Costa ◽  
Ricardo Palma-Dias ◽  
Thomas J. Cade ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Congenital Malformations ◽  
Twin Pregnancy ◽  
Umbilical Artery ◽  
Associated Anomalies ◽  
Fetal Anomalies ◽  
Single Umbilical Artery ◽  
Twin Pregnancies

A single umbilical artery (SUA) was identified in 1.5% of twin pregnancies. The presence of a SUA in a twin pregnancy was associated with a 50% incidence of fetal anomalies, many of them complex and severe. The embryology and pathophysiological mechanisms associated with a SUA are reviewed. Aneuploidy is relatively common and should be considered, particularly in the presence of associated anomalies. Fetal growth restriction is frequent and preterm delivery is common.

scholarly journals Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

2018 ◽  
Vol 20 (3) ◽  
pp. 396
Author(s):  
Andrei Mihai Malutan ◽  
Marina Dudea ◽  
Camelia Albu ◽  
Razvan Ciortea ◽  
Doru Diculescu ◽  
...  
Keyword(s):  
Twin Pregnancy ◽  
Female Fetus ◽  
Monochorionic Twin ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
First Case ◽  
Retroplacental Hematoma ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion

Twin reversed arterial perfusion (TRAP) sequence is a rare and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). We report on the case of a33-year-old female with a biamniotic monochorionic twin pregnancy complicated with TRAP sequence and polyhydramnios. The patient underwent fetoscopic termination of the acardiac twin and at 34 gestational weeks (GW) was readmitted with aretroplacental hematoma. The patient gave birth through caesarean section to a living female fetus, weighing 1480 g. To the best of our knowledge, this is the first case reporting a twin pregnancy with TRAP sequence complicated with retroplacental hematoma.

The role of ultrasound in the prediction of birth weight discordance in twin pregnancies: are we there yet?

2018 ◽  
Vol 46 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Ana Raquel Neves ◽  
Filipa Nunes ◽  
Miguel Branco ◽  
Maria do Céu Almeida ◽  
Isabel Santos Silva
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Predictive Value ◽  
Fetal Growth Restriction ◽  
Predictive Performance ◽  
Growth Restriction ◽  
Operating Characteristics ◽  
Tertiary Center ◽  
Fetal Malformations ◽  
Twin Pregnancies

AbstractObjective:To analyze the accuracy of ultrasound prediction of birth weight discordance (BWD) and the influence of chorionicity and fetal growth restriction (FGR) on ultrasound performance.Methods:Retrospective analysis of 176 twin pregnancies at a Portuguese tertiary center, between 2008 and 2014. Last ultrasound biometry was recorded. Cases with delivery before 24 weeks, fetal malformations, interval between last ultrasound and deliver >3 weeks, twin-to-twin transfusion syndrome and monoamniotic pregnancies were excluded. The accuracy of prediction of BWD was assessed using the area under the receiver-operating characteristics curve (AUC).Results:BWD ≥20% was present in 21.6% of twin pregnancies. EBW had the best predictive performance for BWD (AUC 0.838, 95%CI 0.760–0.916), with a negative predictive value of 86.9% and a positive predictive value of 51.3%. Chorionicity did not influence ultrasound performance. None of the biometric variables analyzed was predictive of BWD in pregnancies without FGR.Conclusion:The accuracy of ultrasound in the prediction of BWD is limited, particularly in pregnancies without fetal growth restriction. Clinical decisions should not rely on BWD alone.

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

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.

First-trimester fetal growth discordance and development of preeclampsia in dichorionic twin pregnancies

2015 ◽  
Vol 43 (6) ◽  
Author(s):  
Tanya Maric ◽  
Natasha Singh ◽  
Keith Duncan ◽  
Guy J. Thorpe-Beeston ◽  
Makrina D. Savvidou
Keyword(s):  
Fetal Growth ◽  
Case Control Study ◽  
Subsequent Development ◽  
First Trimester ◽  
Case Control ◽  
Retrospective Case ◽  
Crown Rump Length ◽  
Significant Difference ◽  
Twin Pregnancies ◽  
Control Study

AbstractTo investigate the relation between first-trimester fetal growth discrepancy, as assessed by crown-rump length (CRL) at 11+0 to 13+6 weeks of gestation, and subsequent development of preeclampsia (PE) in dichorionic diamniotic (DCDA) twin pregnancies. The association between inter-twin CRL and birth weight (BW) discrepancy was also investigated.This was a retrospective, case-control study of DCDA twin pregnancies. Inter-twin CRL discrepancy was calculated as 100×(larger CRL–smaller CRL)/larger CRL. BW discordance was calculated as 100×(larger BW–smaller BW)/larger BW.The study included 299 DCDA pregnancies that remained normotensive and 35 that subsequently developed PE. There was no significant difference in the inter-twin CRL discrepancy between pregnancies complicated by PE and those that were not [3.2%, interquartile range (IQR): 0.5–4.5% vs. 3.3%, IQR: 1.4–5.5%; P=0.17]. There was a positive correlation between inter-twin CRL and BW discrepancy but only in pregnancies that remained normotensive (P<0.001). In women that subsequently developed PE, there was no association between inter-twin CRL and BW discordance (P=0.54).In unselected DCDA twins, first-trimester CRL discrepancy is not different between pregnancies that subsequently develop PE and those that remain normotensive. Furthermore, in pregnancies that are complicated by PE, the association between inter-twin CRL and BW discrepancy appears to be lost.

scholarly journals Ultrasound Assessment of Twin Reversed Arterial Perfusion Sequence for the Prediction of Adverse Pregnancy Outcomes in the First Trimester

2021 ◽  
Author(s):  
Ying Tang ◽  
Yan Zeng ◽  
Taizhu Yang ◽  
Pan Yang ◽  
Shan Bao ◽  
...  
Keyword(s):  
Gestational Age ◽  
Pregnancy Outcomes ◽  
First Trimester ◽  
Adverse Pregnancy Outcomes ◽  
University Hospital ◽  
Intrauterine Death ◽  
Crown Rump Length ◽  
Arterial Perfusion ◽  
Adverse Pregnancy ◽  
Twin Reversed Arterial Perfusion

Abstract ObjectivesTo investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14 weeks. MethodsPregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin’s crown-rump length (CRL) and acardiac twin’s upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL-URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. ResultsTwenty-one pregnant women aged 21–39 years with a gestation of 11-14 weeks were recruited. TRAP was diagnosed on average (± standard deviation [SD]) at pregnancy week 13.1 ± 0.18. The pump twins’ mean (± SD) CRL was 6.65 ± 1.1 cm. The incidence of intrauterine death for the pump twins was 19.0% (n=4), the miscarriage rate was 14.3% (n=3), and the live birth rate was 66.7% (n=14). The (CRL-URL)/CRL ratios between the non-survival (intrauterine death and miscarriage) and survival groups significantly differed (0.33 ± 0.08 vs. 0.58 ± 0.08, p < 0.05). Similarly, the URL/CRL ratios between the non-survival and survival groups significantly differed (0.67 ± 0.08 vs. 0.42 ± 0.08, p < 0.05). ConclusionsThe (CRL-URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.

Sign in / Sign up

Export Citation Format

Share Document