Inter-twin contact in a case of monochorionic diamniotic twins with acrania of one twin fetus at 10–13 weeks’ gestation

Abstract

Anencephaly can be reliably diagnosed using ultrasound late in the first trimester of pregnancy [1]. The prevalence of anencephaly in twins is higher than that in singleton pregnancies, and the prevalence of discordance in anencephaly in monochorionic twins is higher than that in dichorionic twins [2].There have been only two reports on conventional twodimensional (2D) sonographic assessment of fetal behavior in twins discordant because of anencephaly after 20 weeks of gestation [3,4]. However, there has been no report on four-dimensional (4D) sonographic assessment of intertwin contact in twins discordant because of anencephaly in utero. To the best of our knowledge, this is the first report on 4D sonographic assessment of inter-twin contact in a case of monochorionic diamniotic (MD) twins with acrania of one twin fetus late in the first trimester.A 28-year-old Japanese woman, gravida 3, para 1, visited our hospital because of secondary amenorrhea, and MD twin pregnancy at 7 weeks and 4 days was diagnosed. At 11 weeks and 4 days, twin pregnancy with acrania of one twin fetus was diagnosed (Fig. 1). The parents were informed about the lethality of the affected twin fetus, but they elected to continue the pregnancy. At 25 weeks and 1 day, she was admitted to our hospital because of threatened premature labor (short cervix and irritable uterine contractions). At 38 weeks and 4 days, the first of two female infants (anencephalic twin), weighing 1,948 g, and the other infant (second twin), weighing 2,372 g (Apgar score 7 at 1 min and 9 at 5 min; umbilical artery blood pH 7.089), were delivered by elective cesarean section because of two previous cesarean sections. The anencephalic twin died soon after delivery. Permission to conduct an autopsy was not granted by the parents. The second twin is doing well.Detailed descriptions of the data-collecting methods and measurement procedures used in this patient have been presented in a previous publication [5]. In brief, examinations were performed for 30 min with transabdominal 4D sonography at 11 weeks and 4 days and 13 weeks and 1 day of pregnancy, respectively. She was asked whether she would agree to a 30-min observation of fetal movements and inter-twin contact after undergoing routine sonographic examinations. This study was approved by the local ethics committee of Kagawa University School of Medicine, and standardized written informed consent was obtained from the patient. All 4D examinations were performed using Voluson 730 Expert (GE Medical Systems, Milwaukee, WI) with a transabdominal 2-5-MHz transducer. Ten types of inter-twin contact (head to head, head to arm, head to trunk, head to leg, arm to arm, arm to trunk, arm to leg, trunk to trunk, trunk to leg, and leg to leg) were analyzed during playback of the video recordings. The total number of all inter-twin contacts was determined by a single experienced observer (M.S.) and compared to the quartile range obtained from normal MD twins [5]. The frequencies of ten types of inter-twin contact were also compared ...

HDlive and 4D Ultrasound in the Assessment of Twin Pregnancy

“…25). 27 Notably, the frequencies of about half of contacts at 12-13 weeks were low. Hata et al 4 were the first to document reactionary movement in twin fetuses using conventional 3D ultrasound at 25 weeks and 1 day of pregnancy.…”

Current status of fetal neurodevelopmental assessment: Four‐dimensional ultrasound study

“…Our twin study showed that the difference in the frequency of the type of inter‐twin contact at 10–13 GW might be due to early fetal neuromuscular development and differentiation of the neuromuscular system . Moreover, a decreased number of inter‐twin contacts was noted in a case of MD twins with acrania of one of them at 10–13 GW …”

“…27 Moreover, a decreased number of inter-twin contacts was noted in a case of MD twins with acrania of one of them at 10-13 GW. 28 Castiello et al 29 studied kinematic profiles of movements in twin fetuses using 4-D ultrasound at 14 and 18 GW. These authors concluded that the performance of movements towards the co-twin was not accidental, and twin fetuses executed movements specifically aimed at the co-twin already starting from 14 GW.…”

4D Sonography in Assessment of Fetal Neurobehavior

“…The more active twin in each pair showed a close correlation with prenatal intertwin differences in activity. These authors suggested that differences in activity in each pregnancy even before the The quartile ranges at 12 to 13 weeks were adopted from normal monochorionic diamniotic (MD) twins in our previous investigation 46 (Courtesy: Reprinted with permission from Hata T et al) 51 emergence of fetal behavioral patterns were followed by differences in temperament postnatally.…”

“…Hata et al 51 were the first to report on 4D sonographic assessment of intertwin contact in a case of MD twin with an acrania of one twin fetus late in the first trimester (Fig. 21).…”