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ACR Appropriateness Criteria® Multiple Gestations.

, Phyllis Glanc1, David A Nyberg2

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Multiple pregnancies require more frequent ultrasounds for monitoring. Early determination of chorionicity and amnionicity is crucial for managing risks like twin-twin transfusion syndrome.

Keywords:
AUCAppropriate Use CriteriaAppropriateness CriteriaDichorionicMonochorionicMultiple gestation(s)TwinsUltrasound

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Area of Science:

  • Maternal-fetal medicine
  • Radiology
  • Genetics

Background:

  • Multiple gestations, including twin pregnancies, necessitate increased prenatal surveillance compared to singleton pregnancies.
  • These pregnancies face higher risks of complications such as preterm delivery, congenital anomalies, and growth restrictions.
  • Early identification of chorionicity and amnionicity is vital for risk stratification and tailored management.

Purpose of the Study:

  • To outline the increased need for ultrasound examinations in multiple gestations.
  • To highlight the specific risks associated with multiple pregnancies, particularly monochorionic twins.
  • To emphasize the importance of early chorionicity and amnionicity determination for appropriate surveillance.

Main Methods:

  • Review of current medical literature on multiple gestations and associated imaging guidelines.
  • Application of evidence-based methodologies, including RAND/UCLA and GRADE, for guideline development.
  • Annual review by a multidisciplinary expert panel to ensure guideline relevance and accuracy.

Main Results:

  • Monochorionic twins have a higher incidence of congenital heart disease and cardiac abnormalities.
  • Specific complications like twin-twin transfusion syndrome and selective intrauterine growth restriction require close monitoring.
  • The American College of Radiology Appropriateness Criteria provide evidence-based recommendations for imaging in these complex cases.

Conclusions:

  • Enhanced and frequent ultrasound surveillance is essential for managing twin and higher-order pregnancies.
  • Early determination of chorionicity and amnionicity guides the implementation of appropriate surveillance models.
  • Screening for cardiac anomalies is particularly important in monochorionic twins due to their increased risk.