Ultrasound Imaging in Multifetal Pregnancies: Its

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Twins Ultrasound Surveillance All twins - Ultrasound for anomalies at 18 – 20 weeks - Placental Cord Insertions - Weekly Biophysical profile > 32 weeks Dichorionic - Ultrasounds Q 4 weeks for serial growth - Change in AFV and Doppler UA may precede discordant growth Monochorionic twins - Ultrasounds alternate limited and growth, Q 2 weeks, 16 wks - Amniotic fluid volume, bladder - Fetal growth - Doppler blood flow studies - UA, UV, DV and MCA baseline 20 weeks - Repeat if > 20% discordance with smaller < 10% - Uncomplicated or late discordance MCA - Fetal echocardiography
Conclusion Increase awareness of risks associated with MC pregnancies by healthcare providers and patients – “No Dx Twins” • Establish chorionicity early • Risk stratify multifetal pregnancies DC vs. MC – MC pregnancies serial ultrasound beginning at 16 weeks • Limited (MVP, UA and bladder) • Growth studies with Doppler assessment – MFM/Fetal Treatment Center referral consultation for • Targeted ultrasound/echo • Signs of discordance growth or AFV Update ACOG Practice Bulletin #56 October, Multiple Gestation: Complicated Twins, Triplets and High-Order Multifetal Pregnancy 5 3
Page 1 and 2: “Ultrasound Imaging in Multifetal
Page 3 and 4: Perinatal mortality MC vs. DC twins
Page 5 and 6: Complications in Monochorionic Mult
Page 7 and 8: "There is NO diagnosis of twins.”
Page 9 and 10: Ultrasound techniques for determini
Page 11 and 12: Multifetal Pregnancies ~ Establish
Page 13 and 14: Accuracy of referral vs. tertiary d
Page 15 and 16: Bipartite Monochorionic Placentatio
Page 17 and 18: Bahityar MO, J Ultrasound Med 2007;
Page 19 and 20: Maternal-Fetal Surgery: Balancing R
Page 21 and 22: Dilemmas in Management of twins dis
Page 23 and 24: Acardiac Twin
Page 25 and 26: Outcome in TRAP Pregnancies Observa
Page 27 and 28: Twin-twin Transfusion Syndrome
Page 29 and 30: Twin Twin Transfusion Syndrome Diag
Page 31 and 32: Twin-Twin Transfusion Syndrome Stag
Page 33 and 34: Suspected TTTS How often Dx Correct
Page 36 and 37: TAPS Optimal Management is Unclear
Page 38 and 39: Discordant Growth & Selective IUGR
Page 40 and 41: Factors Affecting Fetal Maternal Pl
Page 42 and 43: First trimester prediction Twin com
Page 44 and 45: Discordance & Adverse Outcome by Ch
Page 46 and 47: Monochorionic Twins Selective IUGR
Page 48 and 49: Perinatal outcome with expectant ob
Page 50 and 51: Monochorionic Diamniotic Twins Freq

Ultrasound Imaging in Multifetal Pregnancies: Its

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