Prenatal Diagnosis of Spontaneous Septostomy in Dichorionic Diamniotic Twins and Review of the Literature

Jeanty, Cerine; Newman, Elizabeth; Jeanty, Philippe; Rodts-Palenik, Sheryl

doi:10.7863/jum.2010.29.3.455

Cited by 26 publications

(21 citation statements)

References 13 publications

(15 reference statements)

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“…It seems important to assess the entire intertwin septum to detect these rare partial MC pairs. In contrast to the partial MC twin, partial MA twins have been reported previously and are usually wrongly referred to as pseudo-MA twins and thought to arise from a secondary rupture 12,13 . However, in our opinion, the septum may well be incomplete from the start.…”

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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“…This results from the free floating dividing membrane hampering the view of placental vascular anatomy during laser therapy. This clearly demonstrates that visualization of the intertwin-dividing membrane does not ensure against possible complications of SSDM [9]. Few cases of dizygotic twin pregnancies have also been reported with SSDM [9].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Antepartum Spontaneous Septostomy in a Monochorionic Diamniotic Twin Pregnancy

Chadha

Lange

Bratz

et al. 2012

Case Reports in Obstetrics and Gynecology

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Spontaneous septostomy in a monochorionic diamniotic twin pregnancy is a rare phenomenon. We present a case of monochorionic diamniotic twin pregnancy with an intact dividing membrane seen in the 1st half of the pregnancy. At 26 weeks, when she was assessed for preterm contractions, the dividing membrane was not documented, which suggested spontaneous septostomy. There had been no invasive procedures during the pregnancy. She subsequently delivered at 29 weeks, secondary to preterm labor. No dividing membrane was noticed at the time of caesarian section. Spontaneous septostomy can complicate the management of monochorionic diamniotic twins by creating a pseudomonoamniotic environment resulting in cord entanglement, and difficulty in the diagnosis and management of twin-twin transfusion syndrome. We believe that such a case should be managed as monochorionic monoamniotic twin gestation.

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“…[53][54] Umbilical cord entanglement This complication is specific of MCMA twinning but has also been described after spontaneous and iatrogenous septostomy in both MCDA and DCDA twins. [55][56][57][58] Cord entanglement can be detected with ultrasound from 10 gestational weeks using the so-called "Y sign" (Figure 2). Cord entanglement has been associated with a high incidence of intrauterine fetal death.…”

Section: Zygosity Vs Chorionicitymentioning

confidence: 99%