Ultrasound and histological measurements of dividing membrane thickness in twin gestations

Bracero, Luis A.; Huff, Cristina Wallace; Blitz, Matthew J.; Plata, Milton; Seybold, Dara; Broce, Mike

doi:10.1002/uog.17337

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…is irregularly thickened 15.0 mm dividing membrane was not a normal variant, as the vast majority of dichorionic twins show thickness between 1.9 and 3.6 mm [2,3]. Di erential diagnosis could include a circumvallate placenta, an amniotic band, uterine synechiae, uterine congenital abnormalities, or membranes from a vanishing twin.…”

Section: Discussionmentioning

confidence: 99%

A Case of Intertwin Membrane Hemorrhage with Spontaneous Resolution

Criscione

Elmezzi

Torrealday

et al. 2019

Case Reports in Obstetrics and Gynecology

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Vaginal bleeding during pregnancy places women at increased risk of spontaneous abortion. Etiologies for threatened and spontaneous abortions have been well studied, but there is little information on intertwin membrane hemorrhage. We present a patient with a multiple gestation pregnancy who experienced first trimester vaginal bleeding with visualization and subsequent rapid resolution of an intertwin membrane hemorrhage. The patient had an otherwise normal pregnancy until the third trimester when she developed preeclampsia with severe features and elected for a primary cesarean section at 35 + 5 weeks. The implications of an intertwin membrane hemorrhage are not well understood, although there could be a possible correlation between the hemorrhage and the ultimate progression to preeclampsia with severe features. Despite the final diagnosis, the patient did not have any noticeable complications due to the hemorrhage both when it was discovered and in the weeks following its discovery.

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Section: Discussionmentioning

confidence: 99%

A Case of Intertwin Membrane Hemorrhage with Spontaneous Resolution

Criscione

Elmezzi

Torrealday

et al. 2019

Case Reports in Obstetrics and Gynecology

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“…When using 2-dimensional ultrasound, an intertwin membrane thickness of 1.5 to 2.0 mm may be inconclusive for MC twins. Bracero et al 9 reported that a cutoff value of 1.9 mm of the dividing membrane thickness is found to be the best predictor of chorionicity with the ultrasound beam parallel. However, there is still no consensus about the optimal cutoff value.…”

Section: Determination Of Chorionicity Of Twin Pregnancymentioning

confidence: 99%

The Controversies and Challenges in the Management of Twin Pregnancy: From the Perspective of International Federation of Gynecology and Obstetrics Guidelines

Liu

Zhao

et al. 2022

Maternal Fetal Med

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The rate of multiple pregnancy is increasing, mainly because of the widespread use of assisted reproduction techniques and families’ desire for twins. Twin pregnancy accounts for a higher risk of chromosomal abnormalities, structural malformations, and neonatal adverse events than singleton pregnancy. The presence of artery-vein anastomoses, unbalanced placenta sharing, and abnormal cord insertion in monochorionic twins is associated with twin complications such as twin-to-twin transfusion syndrome, selective intrauterine growth restriction, and twin anemia polycythemia sequence. Although many guidelines and studies have established and improved the processes about the antenatal surveillance and management of twin pregnancy, they also raise more controversies and challenges. This review aims to highlight the international consensus on the antenatal care of twin pregnancies and analyze the controversies and predicaments based on the published International Federation of Gynecology and Obstetrics guidelines and research.

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“…Also, the impression of a false-positive lambda sign can be created when an umbilical cord insertion opens directly into the membrane between the fetuses [8]. Other described clues to determine chorionicity include membrane thickness measurement (≥ 1.9 mm dichorionic) [9], the number of membrane layers (2 thin amniotic membranes in monochorionic or 3 layers in dichorionic twins with 2 amniotic membranes and a chorionic layer in between) or determination of the fetal sexes [7].…”

Section: Datierung Der Zwillingsschwangerschaftmentioning

confidence: 99%

“…Auch kann der Eindruck eines falsch positiven Lambda-Zeichen entstehen, wenn ein Nabelschnuransatz direkt in die Membran zwischen den Föten mündet [8]. Weitere beschriebene Hinweiszeichen zur Festlegung der Chorionizität sind die Membrandickenmessung (≥ 1,9 mm dichorial) [9], das Zählen der Membranschichten (2 dünne Amnionmembranen bei monochorialen oder 3 Schichten bei dichorialen Zwillingen mit 2 Amnionmembranen und einer Chorionschicht dazwischen) oder die Bestimmung der fetalen Geschlechter [7].…”

Section: Noteunclassified

Twin pregnancies

Ochsenbein‐Kölble

2021

Ultraschall Med

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Twin pregnancies, resulting in 2–3 % of all deliveries, are high risk pregnancies which need specialized care. A correct dating of pregnancy and the assessment of the chorionicity/amnionicity in the first trimester (< = 13 + 6 gestational weeks, GW) is essential for further monitoring. During first trimester risk stratification of monochorionic pregnancies includes evaluation of discordance of crown-rump-lengths, nuchal translucencies and amniotic fluid. At 16 GW sonographic risk evaluation of monochorionic twins involves differences in amniotic fluid and abdominal circumferences and detection of a velamentous cord insertion. A screening for fetal malformations with cervical length measurement as screening for preterm birth (cut-off < 25 mm) should be offered all twin pregnancies around 20 GW. In uncomplicated dichorionic pregnancies US examination should be performed every 4 weeks onwards to check fetal growth and amniotic fluid. An intertwin weight discordance > 20 % identifies pregnancies at increased risk of adverse outcome. Monochorionic pregnancies should be followed at least every two weeks for screening of twin-twin transfusion syndrome (TTTS), twin-anemia-polycythemia-sequence (TAPS) and selective fetal growth retardation (sFGR) with a start at 16 GW. The type 1–3 classification of sFGR in monochorionic twins depends on the pattern of end-diastolic velocity at the umbilical artery Doppler. The diagnosis of TTTS requires the presence of an oligyohydramnios (deepest vertical pocket (DVP) < 2 cm) in the donor twin and a polyhydramnios (DVP > 8 cm) in the recipient twin. However, the diagnosis of TAPS is based on the finding of discordant MCA Doppler values with a delta-MCA PV > 0.5 MoM.

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Ultrasound and histological measurements of dividing membrane thickness in twin gestations

Cited by 4 publications

References 25 publications

A Case of Intertwin Membrane Hemorrhage with Spontaneous Resolution

A Case of Intertwin Membrane Hemorrhage with Spontaneous Resolution

The Controversies and Challenges in the Management of Twin Pregnancy: From the Perspective of International Federation of Gynecology and Obstetrics Guidelines

Twin pregnancies

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