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
-
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
-
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
-
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
-
5
Sherer D M.
Adverse perinatal outcome of twin pregnancies according to chorionicity: review of the literature.
Am J Perinatol.
2001;
18
23-37
-
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
-
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
-
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
-
9
Sepulveda W, Sebire N J, Nicolaides K H.
The lambda sign in twin pregnancies.
Ultrasound Obstet Gynecol.
1996;
8
429
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
18
Wee L Y, Muslim I.
Perinatal complications of monochorionic placentation.
Curr Opin Obstet Gynecol.
2007;
19
554-560
-
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
-
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
-
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
-
22
Blaicher W, Repa C, Schaller A.
Acardiac twin pregnancy: associated with trisomy 2: case report.
Hum Reprod.
2000;
15
474-475
-
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
-
24
Hubinont C, Kollmann P, Malvaux V, Donnez J, Bernard P.
First-trimester diagnosis of conjoined twins.
Fetal Diagn Ther.
1997;
12
185-187
-
25
Pajkrt E, Jauniaux E.
First-trimester diagnosis of conjoined twins.
Prenat Diagn.
2005;
25
820-826
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
42
Manning N.
The influence of twinning on cardiac development.
Early Hum Dev.
2008;
84
173-179
-
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
-
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
-
45
Weisz B, Rodeck C H.
Invasive diagnostic procedures in twin pregnancies.
Prenat Diagn.
2005;
25
751-758
-
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
-
47
Schreck R R, Falik-Borenstein Z, Hirata G.
Chromosomal mosaicism in chorionic villus sampling.
Clin Perinatol.
1990;
17
867-888
-
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
-
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
-
50
Spadola A C, Simpson L L.
Selective termination procedures in monochorionic pregnancies.
Semin Perinatol.
2005;
29
330-337
Corinne HubinontM.D. Ph.D.
Department of Obstetrics, Saint Luc University Hospital
University de Louvain, B- 1200 Brussels, Belgium
Email: corinne.hubinont@uclouvain.be
