Ultrasound Imaging in Multifetal Pregnancies PDF
Preview Ultrasound Imaging in Multifetal Pregnancies
“Ultrasound Imaging in Multifetal Pregnancies: Its More than Chorionicity” Anthony Johnson, DO Professor, UTHSC, Houston, TX Co-Director, Texas Fetal Center, CMHH 1 Disclosures • I have no relationships with commercial companies that could be perceived as a conflict of interest. • I will not be discussing the use of products that are investigational or approved devices that are being used “off label ” Perinatal mortality MC vs. DC twins Dutch cohort study 1995-2004 Outcome MC DC Hazard Risk (n = 198) (1107) (95%CI) Perinatal 11.6% 5.0% 2.44 Mortality (1.73-3.44) Stillbirth 7.6% 1.5% 5.21 (3.18-8.51) Screening protocol: - 1st trimester ultrasound for chorionicity - 20 wks anatomic survey - Serial ultrasounds (fortnightly) for growth, AFV and Doppler assessment Hack KEA et al BJOG 2008;115:58-67 Outcome of MCDA twin gestations in the era of invasive fetal therapy Survival Twin live births 172 85% Singleton 15 7% Double demise 15 7% Complication TTTS 18 9% sIUGR 30 15% Losses Total 11% (TTTS ~ 42%) < 24 weeks 84% > 24 weeks 16% > 32 weeks 1% Extra loss in MC twins is due to complications placental anastomoses Lewi et al., 2008 Complications in Monochorionic Multi-Fetal Pregnancies Twin-Twin Transfusion Syndrome • - Oligo/Polyhydramnios Sequence ~ TOPS - Twin Anemia Polycythemia Sequence ~ TAPS • Twin Reverse Arterial Perfusion • Growth Discordance • Discordant malformations - Structural - Chromosomal • Monoamnioitc Diagnosis There is NO diagnosis of twins.” " “The only diagnosis is a monochorionic or dichorionic twin gestation. This should be written in capital red letters on the front of the chart at 8 - 10 weeks". K Nicolaides, 02/27/09 Multifetal Pregnancies Ultrasound Determination of Amnionicity & Chorionicity 1st Trimester Ultrasound Examination: - Amnionicity and chorionicity should be documented for all multiple gestations when possible. 2nd & 3rd Trimester Ultrasound Examination: - Multiple gestations require the documentation of additional information: chorionicity, amnionicity, comparison of fetal sizes, estimation of amniotic fluid volume on each side of the membrane, and fetal genitalia (when visualized). AIUM PRACTICE GUIDELINES, Oct 2007 ACOG PRACTICE GUIDELINES, #101, Reaffirmed 2011 Ultrasound techniques for determining chorionicity & amnionicity Umbilical cord entanglement Fetal sex Separate placental discs No. of layers in membrane Membrane thickness Lambda or Twin Peaks or T-sign No. of yolk sacs amnionicity No. of gestational sacs chorionicity First trimester Second Trimester Third Trimester J Robinson & AZ Abuhamad Modern Medicine 2002 Multifetal Pregnancies Chorionicity Monochorionic Dichorionic “T” sign Lambda or Twin Peak sign Moise KJ Texas Medicine 2007
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