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Sonographic considerations with multiple gestation

M E Rode1, M Jackson

  • 1Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA.

Seminars in Roentgenology
|February 16, 1999
PubMed
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Determining chorionicity early is crucial for twin pregnancy risk management. Ultrasound in the first trimester identifies placental type, guiding monitoring for complications like twin-twin transfusion syndrome and growth discordance.

Area of Science:

  • Maternal-Fetal Medicine
  • Diagnostic Imaging
  • Perinatology

Background:

  • Chorionicity determination is vital for managing twin pregnancies and assessing risks.
  • Early identification of placental type influences clinical management strategies.
  • Twin pregnancies face higher risks of complications, necessitating precise monitoring.

Purpose of the Study:

  • To outline the importance of chorionicity determination in twin pregnancies.
  • To describe ultrasound markers for differentiating dichorionic and monochorionic twins.
  • To detail the recommended surveillance protocols based on chorionicity.

Main Methods:

  • First-trimester ultrasonography to assess placental membranes, placental masses, and the "twin peak" sign.
  • Evaluation of amniotic fluid volume for potential complications.

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  • Monitoring fetal growth discordance using estimated fetal weight with a > or = 20% intertwin difference.

    • Main Results:

    • Dichorionic placentation is suggested by easily visualized membranes, a "twin peak" sign, separate placentas, and discordant gender.
    • Monochorionic placentation shows a single placental mass and difficult-to-visualize membranes until late first trimester.
    • Fetal growth discordance, indicated by a > or = 20% difference in estimated fetal weight, is a significant finding.

    Conclusions:

    • Accurate chorionicity determination via first-trimester ultrasound is essential for risk stratification in twin pregnancies.
    • Regular ultrasound surveillance tailored to chorionicity is critical for early detection of twin-twin transfusion syndrome and growth issues.
    • Management protocols should include serial growth and amniotic fluid assessments, with specific attention to monochorionic pregnancies.