Chorionicity determination in twin pregnancies: how accurate are we?

Stenhouse, Emily; Hardwick, Chris; Maharaj, S.; Webb, John; Kelly, Teresa; Mackenzie, Fiona

doi:10.1046/j.1469-0705.2002.00679.x

Cited by 102 publications

(60 citation statements)

References 13 publications

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“…In the management of twin pregnancies, the first-trimester ultrasound examination is of critical importance as it distinguishes the high-risk MC pregnancy from the lower-risk DC pregnancy with high accuracy 2,3 . MC twins are considered to be at increased risk of adverse outcome compared to DC twins because of vascular anastomoses on the placenta [4][5][6] .…”

Section: Discussionmentioning

confidence: 99%

Partial monochorionic and monoamniotic twin pregnancies: a report of two cases

Galjaard

Moerman²,

Corveleyn

et al. 2014

Ultrasound Obstet Gynecol

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Monochorionic (MC) twin pregnancies are at increased CASE REPORTSThe first case was a spontaneous twin pregnancy of a 25-year-old woman, gravida 2 para 1, referred at 12 weeks' gestation for chorionicity determination. Ultrasound showed only two thin separating amniotic membranes at the lower part of the intertwin septum and one thick chorionic membrane in conjunction with two thin amniotic membranes at the upper part (Figure 1), resulting in the diagnosis of a partial monochorionic (MC) twin pregnancy. The pregnancy was followed up as an MC twin pregnancy with fortnightly ultrasound examinations. The pregnancy was uneventful and the patient delivered two healthy girls of 2535g and 2595g at 36 weeks' gestation. Postnatal macroscopic evaluation of the intertwin membrane confirmed our diagnosis, showing both an opaque and a translucent part of the septum (Figure 2). Placental injection documented the presence of vascular anastomoses across the MC part of the septum. Pathological examination of the intertwin septum confirmed both the amnion-amnion and amnion-chorion-amnion attachment, indicating a partial MC and dichorionic (DC) septum (Figure 3), as was diagnosed at the first-trimester scan. DNA fingerprinting using fibroblasts cultured from the umbilical cords confirmed monozygosity.The second case was a twin pregnancy conceived by intracytoplasmatic sperm injection in a 26-year-old woman, gravida 3 para 1. The first-trimester scan showed two thin amniotic membranes (Figure 4, inset), typical in an MC diamniotic (DA) twin pregnancy, and a fortnightly follow-up scan was recommended. Re-evaluation at 20 weeks' gestation showed that the intertwin septum no longer separated the two twins, but that both were on the same side of the septum and their cords were entangled. The initial diagnosis of a diamniotic pregnancy was therefore changed to a partial monoamniotic (MA) pregnancy. From 28 weeks onwards, the woman was managed as an inpatient to provide fetal surveillance and treatment for fetal lung maturation, as is usual for MA pairs1 . An emergency Cesarean section was performed at 31 weeks' gestation because of preterm prelabor rupture of membranes and the clinical suspicion of placental abruption. Two healthy boys of 1630g and 1440g were delivered. Postpartum macroscopic evaluation confirmed the presence of cord entanglement and revealed a partial DA intertwin septum between the cord insertions (Figure 4). Examination of the injected placenta documented the presence of vascular anastomoses, as typically seen in MC placentas.

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Section: Discussionmentioning

confidence: 99%

Partial monochorionic and monoamniotic twin pregnancies: a report of two cases

Galjaard

Moerman²,

Corveleyn

et al. 2014

Ultrasound Obstet Gynecol

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“…Ultrasound assessment of chorionicity is becoming popular and has been shown to have high sensitivity and specificity with increased accuracy if performed prior to 14 weeks' gestation (Scardo et al, 1995;Stenhouse et al, 2002). Stenhouse et al (2002) found that chorionicity can be accurately determined in over 95% of cases when antenatal transabdominal ultrasound is used. This level of accuracy, if routinely used, would allow not only improved clinical care but also aid in unravelling the mystery that still surrounds the exact influence that the chorion has on development.…”

Section: Figurementioning

confidence: 99%

Chorion Type, Birthweight Discordance and Tooth-Size Variability in Australian Monozygotic Twins

Race¹,

Townsend²,

Hughes³

2006

twin res hum genet

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“…In recent years it has been recognized that many of the adverse outcomes are related to monochorionic placentation 22 , and management of twin pregnancies is now firmly based around targeted ultrasound examinations for planning of further antenatal care and surveillance. A sonographic examination at 11-14 weeks of gestation allows accurate determination of chorionicity [30][31][32][33] , measurement of fetal nuchal translucency thickness for determination of risk for fetal trisomies 34,35 , and discordance for major fetal anomalies 36,37 . In monochorionic twin pregnancies, further examinations in early mid-trimester may allow detection of developing twinto-twin transfusion syndrome 38,39 .…”

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confidence: 99%