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Am J Perinatol 2010; 27(8): 595-598
DOI: 10.1055/s-0030-1249360
© Thieme Medical Publishers

A Systematic Approach to First-trimester Ultrasound Assessment of Twins

Corinne Hubinont1 , Joaquin Santolaya-Forgas2
  • 1Department of Obstetrics, Saint Luc University Hospital, University de Louvain, B- 1200 Brussels, Belgium
  • 2Department of Obstetrics and Gynaecology, Brigham and Women Hospital, Harvard Medical School, Boston, Massachusetts
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Publication History

Publication Date:
02 March 2010 (online)

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ABSTRACT

The incidence of twin pregnancies has increased for the last 20 years mainly as a result of assisted reproduction technologies and pregnancies occurring in older women. Both maternal and perinatal mortality and morbidity are increased in twin pregnancies when compared with singletons. A systematic and detailed first-trimester ultrasound can be a useful tool for detecting chorionicity, growth discordance, and congenital malformations. Prediction of complications at an early stage can help with directing future management and counseling of patients.

KEYWORDS

First-trimester ultrasound - multiple pregnancies - chorionicity - cervical length - fetal growth - nuchal translucency

REFERENCES

  • 1 Russell R B, Petrini J R, Damus K, Mattison D R, Schwarz R H. The changing epidemiology of multiple births in the United States.  Obstet Gynecol. 2003;  101 129-135
    Search in Google Scholar
  • 2 Ananth C V, Joseph Ks K, Smulian J C. Trends in twin neonatal mortality rates in the United States, 1989 through 1999: influence of birth registration and obstetric intervention.  Am J Obstet Gynecol. 2004;  190 1313-1321
    CrossrefPubMedSearch in Google Scholar
  • 3 Topp M, Huusom L D, Langhoff-Roos J, Delhumeau C, Hutton J L, Dolk H. SCPE Collaborative Group . Multiple birth and cerebral palsy in Europe: a multicenter study.  Acta Obstet Gynecol Scand. 2004;  83 548-553
    CrossrefPubMedSearch in Google Scholar
  • 4 Sebire N J, Snijders R J, Hughes K, Sepulveda W, Nicolaides K H. The hidden mortality of monochorionic twin pregnancies.  Br J Obstet Gynaecol. 1997;  104 1203-1207
    PubMedSearch in Google Scholar
  • 5 Sherer D M. Adverse perinatal outcome of twin pregnancies according to chorionicity: review of the literature.  Am J Perinatol. 2001;  18 23-37
    Search in Google Scholar
  • 6 Moise Jr K J, Johnson A, Moise K Y, Nickeleit V. Radiofrequency ablation for selective reduction in the complicated monochorionic gestation.  Am J Obstet Gynecol. 2008;  198 198-5 e1-e5
    PubMedSearch in Google Scholar
  • 7 Hill L M, Chenevey P, Hecker J, Martin J G. Sonographic determination of first trimester twin chorionicity and amnionicity.  J Clin Ultrasound. 1996;  24 305-308
    CrossrefPubMedSearch in Google Scholar
  • 8 Sherer D M, Sokolovski M, Haratz-Rubinstein N. Diagnosis of umbilical cord entanglement of monoamniotic twins by first-trimester color Doppler imaging.  J Ultrasound Med. 2002;  21 1307-1309
    PubMedSearch in Google Scholar
  • 9 Sepulveda W, Sebire N J, Nicolaides K H. The lambda sign in twin pregnancies.  Ultrasound Obstet Gynecol. 1996;  8 429
    PubMedSearch in Google Scholar
  • 10 Carroll S G, Soothill P W, Abdel-Fattah S A, Porter H, Montague I, Kyle P M. Prediction of chorionicity in twin pregnancies at 10–14 weeks of gestation.  BJOG. 2002;  109 182-186
    PubMedSearch in Google Scholar
  • 11 Bromley B, Benacerraf B R. Using the number of yolk sacs to determine amnionicity in early first trimester monochorionic twins.  J Ultrasound Med. 1995;  14 415-419
    PubMedSearch in Google Scholar
  • 12 Shen O, Samueloff A, Beller U, Rabinowitz R. Number of yolk sacs does not predict amnionicity in early first-trimester monochorionic multiple gestations.  Ultrasound Obstet Gynecol. 2006;  27 53-55
    CrossrefPubMedSearch in Google Scholar
  • 13 To M S, Fonseca E B, Molina F S, Cacho A M, Nicolaides K H. Maternal characteristics and cervical length in the prediction of spontaneous early preterm delivery in twins.  Am J Obstet Gynecol. 2006;  194 1360-1365
    CrossrefPubMedSearch in Google Scholar
  • 14 Roman A S, Rebarber A, Pereira L, Sfakianaki A K, Mulholland J, Berghella V. The efficacy of sonographically indicated cerclage in multiple gestations.  J Ultrasound Med. 2005;  24 763-768 quiz 770-771
    PubMedSearch in Google Scholar
  • 15 Tai J, Grobman W A. The association of crown-rump length discordance in twin gestations with adverse perinatal outcomes.  Am J Obstet Gynecol. 2007;  197 369-372 e1-e4
    PubMedSearch in Google Scholar
  • 16 El Kateb A, Nasr B, Nassar M, Bernard J P, Ville Y. First-trimester ultrasound examination and the outcome of monochorionic twin pregnancies.  Prenat Diagn. 2007;  27 922-925
    CrossrefPubMedSearch in Google Scholar
  • 17 Lewi L, Lewi P, Diemert A et al.. The role of ultrasound examination in the first trimester and at 16 weeks' gestation to predict fetal complications in monochorionic diamniotic twin pregnancies.  Am J Obstet Gynecol. 2008;  199 493 e1-e7
    PubMedSearch in Google Scholar
  • 18 Wee L Y, Muslim I. Perinatal complications of monochorionic placentation.  Curr Opin Obstet Gynecol. 2007;  19 554-560
    CrossrefPubMedSearch in Google Scholar
  • 19 Sebire N J, Souka A, Skentou H, Geerts L, Nicolaides K H. Early prediction of severe twin-to-twin transfusion syndrome.  Hum Reprod. 2000;  15 2008-2010
    CrossrefPubMedSearch in Google Scholar
  • 20 Matias A, Ramalho C, Montenegro N. Search for hemodynamic compromise at 11–14 weeks in monochorionic twin pregnancy: is abnormal flow in the ductus venosus predictive of twin-twin transfusion syndrome?.  J Matern Fetal Neonatal Med. 2005;  18 79-86
    CrossrefPubMedSearch in Google Scholar
  • 21 Stiller R J, Romero R, Pace S, Hobbins J C. Prenatal identification of twin reversed arterial perfusion syndrome in the first trimester.  Am J Obstet Gynecol. 1989;  160(5 Pt 1) 1194-1196
    PubMedSearch in Google Scholar
  • 22 Blaicher W, Repa C, Schaller A. Acardiac twin pregnancy: associated with trisomy 2: case report.  Hum Reprod. 2000;  15 474-475
    CrossrefPubMedSearch in Google Scholar
  • 23 Kamitomo M, Kouno S, Ibuka K et al.. First-trimester findings associated with twin reversed arterial perfusion sequence.  Fetal Diagn Ther. 2004;  19 187-190
    CrossrefPubMedSearch in Google Scholar
  • 24 Hubinont C, Kollmann P, Malvaux V, Donnez J, Bernard P. First-trimester diagnosis of conjoined twins.  Fetal Diagn Ther. 1997;  12 185-187
    CrossrefPubMedSearch in Google Scholar
  • 25 Pajkrt E, Jauniaux E. First-trimester diagnosis of conjoined twins.  Prenat Diagn. 2005;  25 820-826
    CrossrefPubMedSearch in Google Scholar
  • 26 Spencer K, Kagan K O, Nicolaides K H. Screening for trisomy 21 in twin pregnancies in the first trimester: an update of the impact of chorionicity on maternal serum markers.  Prenat Diagn. 2008;  28 49-52
    CrossrefPubMedSearch in Google Scholar
  • 27 Hui P W, Tang M H, Ng E H, Yeung W S, Ho P C. Nuchal translucency in dichorionic twins conceived after assisted reproduction.  Prenat Diagn. 2006;  26 510-513
    CrossrefPubMedSearch in Google Scholar
  • 28 Wøjdemann K R, Larsen S O, Shalmi A C, Sundberg K, Tabor A, Christiansen M. Nuchal translucency measurements are highly correlated in both mono- and dichorionic twin pairs.  Prenat Diagn. 2006;  26 218-220
    CrossrefPubMedSearch in Google Scholar
  • 29 Chasen S T, Perni S C, Kalish R B, Chervenak F A. First-trimester risk assessment for trisomies 21 and 18 in twin pregnancy.  Am J Obstet Gynecol. 2007;  197 374 e1-e3
    PubMedSearch in Google Scholar
  • 30 Zoppi M A, Ibba R M, Axiana C, Floris M, Manca F, Monni G. Absence of fetal nasal bone and aneuploidies at first-trimester nuchal translucency screening in unselected pregnancies.  Prenat Diagn. 2003;  23 496-500
    CrossrefPubMedSearch in Google Scholar
  • 31 Cleary-Goldman J, Rebarber A, Krantz D, Hallahan T, Saltzman D. First-trimester screening with nasal bone in twins.  Am J Obstet Gynecol. 2008;  199 283 e1-e3
    PubMedSearch in Google Scholar
  • 32 Cheng P J, Shaw S W, Shih J C, Soong Y K. Monozygotic twins discordant for monosomy 21 detected by first-trimester nuchal translucency screening.  Obstet Gynecol. 2006;  107(2 Pt 2) 538-541
    CrossrefPubMedSearch in Google Scholar
  • 33 Dahoun S, Gagos S, Gagnebin M et al.. Monozygotic twins discordant for trisomy 21 and maternal 21q inheritance: a complex series of events.  Am J Med Genet A. 2008;  146A 2086-2093
    CrossrefPubMedSearch in Google Scholar
  • 34 West P M, Love D R, Stapleton P M, Winship I M. Paternal uniparental disomy in monozygotic twins discordant for hemihypertrophy.  J Med Genet. 2003;  40 223-226
    CrossrefPubMedSearch in Google Scholar
  • 35 Gassner R, Metzenbauer M, Hafner E, Vallazza U, Philipp K. Triploidy in a twin pregnancy: small placenta volume as an early sonographical marker.  Prenat Diagn. 2003;  23 16-20
    CrossrefPubMedSearch in Google Scholar
  • 36 Wee L, Jauniaux E. Prenatal diagnosis and management of twin pregnancies complicated by a co-existing molar pregnancy.  Prenat Diagn. 2005;  25 772-776
    CrossrefPubMedSearch in Google Scholar
  • 37 Sumigama S, Itakura A, Yamamoto T et al.. Genetically identified complete hydatidiform mole coexisting with a live twin fetus: comparison with conventional diagnosis.  Gynecol Obstet Invest. 2007;  64 228-231
    PubMedSearch in Google Scholar
  • 38 Smrcek J M, Germer U, Krokowski M et al.. Prenatal ultrasound diagnosis and management of body stalk anomaly: analysis of nine singleton and two multiple pregnancies.  Ultrasound Obstet Gynecol. 2003;  21 322-328
    CrossrefPubMedSearch in Google Scholar
  • 39 Bulbul Y, Drummond C L, Hillion Y, Bidat L, Ville Y. Diprosopus associated with neural tube defect and facial cleft in the first trimester.  Fetal Diagn Ther. 2004;  19 246-250
    CrossrefPubMedSearch in Google Scholar
  • 40 Vandecruys H, Avgidou K, Surerus E, Flack N, Nicolaides K H. Dilemmas in the management of twins discordant for anencephaly diagnosed at 11 + 0 to 13 + 6 weeks of gestation.  Ultrasound Obstet Gynecol. 2006;  28 653-658
    CrossrefPubMedSearch in Google Scholar
  • 41 Sperling L, Kiil C, Larsen L U et al.. Detection of chromosomal abnormalities, congenital abnormalities and transfusion syndrome in twins.  Ultrasound Obstet Gynecol. 2007;  29 517-526
    CrossrefPubMedSearch in Google Scholar
  • 42 Manning N. The influence of twinning on cardiac development.  Early Hum Dev. 2008;  84 173-179
    CrossrefPubMedSearch in Google Scholar
  • 43 Maiz N, Plasencia W, Dagklis T, Faros E, Nicolaides K. Ductus venosus Doppler in fetuses with cardiac defects and increased nuchal translucency thickness.  Ultrasound Obstet Gynecol. 2008;  31 256-260
    CrossrefPubMedSearch in Google Scholar
  • 44 De Catte L, Liebaers I, Foulon W. Outcome of twin gestations after first trimester chorionic villus sampling.  Obstet Gynecol. 2000;  96(5 Pt 1) 714-720
    CrossrefPubMedSearch in Google Scholar
  • 45 Weisz B, Rodeck C H. Invasive diagnostic procedures in twin pregnancies.  Prenat Diagn. 2005;  25 751-758
    CrossrefPubMedSearch in Google Scholar
  • 46 Brambati B, Tului L, Camurri L, Guercilena S. First-trimester fetal reduction to a singleton infant or twins: outcome in relation to the final number and karyotyping before reduction by transabdominal chorionic villus sampling.  Am J Obstet Gynecol. 2004;  191 2035-2040
    CrossrefPubMedSearch in Google Scholar
  • 47 Schreck R R, Falik-Borenstein Z, Hirata G. Chromosomal mosaicism in chorionic villus sampling.  Clin Perinatol. 1990;  17 867-888
    PubMedSearch in Google Scholar
  • 48 Evans M I, Kaufman M I, Urban A J, Britt D W, Fletcher J C. Fetal reduction from twins to a singleton: a reasonable consideration?.  Obstet Gynecol. 2004;  104 102-109
    CrossrefPubMedSearch in Google Scholar
  • 49 Stone J, Ferrara L, Kamrath J et al.. Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR).  Am J Obstet Gynecol. 2008;  199 406 e1-e4
    PubMedSearch in Google Scholar
  • 50 Spadola A C, Simpson L L. Selective termination procedures in monochorionic pregnancies.  Semin Perinatol. 2005;  29 330-337
    CrossrefPubMedSearch in Google Scholar

Corinne HubinontM.D. Ph.D. 

Department of Obstetrics, Saint Luc University Hospital

University de Louvain, B- 1200 Brussels, Belgium

Email: corinne.hubinont@uclouvain.be