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Wang Y, Qiu X, Chen S, Pan D, Hua R, Li S, Chen Y, Pan N, Cai X, Li J, Zhao X, Wang J, Jing R, Xiang G, Zhang Z, Huang HF, Xu C, Zhang J. Noninvasive Evaluation of Fetal Zygosity in Twin Pregnancies Involving a Binary Analysis of Single-Nucleotide Polymorphisms. J Mol Diagn 2023; 25:682-691. [PMID: 37599029 DOI: 10.1016/j.jmoldx.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/03/2023] [Accepted: 06/01/2023] [Indexed: 08/22/2023] Open
Abstract
Twin pregnancy constitutes significant risks for maternal and fetal health, which is usually detected by ultrasound examination at early gestation. However, the imaging-based approach may not accurately identify all twins confounded by practical or clinical variables. The analysis of fetal cell-free DNA in noninvasive prenatal screening assays can completement the ultrasound method for twin detection, which differentiates fraternal or identical twins based on their distinct genotypes. Here, a new noninvasive prenatal screening employing high-coverage next-generation sequencing for targeted nucleotide polymorphisms was developed for detection of zygosity and determination of fetal fraction in twin pregnancies. This method utilizes a binary analysis of both the number and allelic fraction of fetus-specific single-nucleotide polymorphisms to infer the zygosity. In 323 samples collected from 215 singleton, 90 dizygotic, and 18 monozygotic twin pregnancies, all 90 dizygotic twins were correctly detected, with a 100% sensitivity and a 100% specificity. In addition, this method can detect complex pregnancies, such as egg donors, contamination, and twins with complete hydatidiform mole. The fetus-specific fetal fraction change was monitored in nine dizygotic twin pregnancies, which demonstrated highly variable dynamics of fetal cell-free DNA turnover up to 7 weeks after twin reduction. Overall, this study provides a new noninvasive prenatal screening strategy for the accurate identification of twin zygosity and quantification of fetal fraction, which has important clinical implications for the management of twin pregnancies.
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Affiliation(s)
- Yanlin Wang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
| | - Xiang Qiu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Songchang Chen
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Dong Pan
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Renyi Hua
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuyuan Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yiyao Chen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Nina Pan
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoqiang Cai
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Jianli Li
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Xin Zhao
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Jing Wang
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Ruilin Jing
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - Guangxin Xiang
- Beijing BioBiggen Technology Co., Ltd., Beijing, China; School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhiwei Zhang
- Beijing BioBiggen Technology Co., Ltd., Beijing, China
| | - He-Feng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Chenming Xu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Jinglan Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China; Beijing BioBiggen Technology Co., Ltd., Beijing, China.
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Lu J, Ting YH, Leung TY. Determining chorionicity and amnionicity in twin pregnancies: Pitfalls. Best Pract Res Clin Obstet Gynaecol 2022; 84:2-16. [PMID: 35490102 DOI: 10.1016/j.bpobgyn.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 11/02/2022]
Abstract
Although the accuracy of chorioamnionicity determination in multiple pregnancy is nearly 100%, some pitfalls do exist. These pitfalls may arise from some confusing sonographic appearance or because of certain rare variations of twinning going against the general principles. Pitfalls in chorionicity determination include (1) the disappearance of the twin peak sign with the regression of chorion frondosum and thinning of the intertwin membrane with advancing gestation; (2) fake twin peak sign because of other structures creeping into the intertwin membrane-placental junction; (3) intrauterine septum or synechia being mistaken as a thick intertwin membrane; (4) bipartite placenta in monochorionic twin being misinterpreted as two separate placentas of dichorionic twin; (5) erroneous fetal sex determination in sex chromosome mosaicism, monogenic disorders, and malformed genitalia in one fetus; and (6) rare twinning types such as dizygotic monochorionic twin and sesquizygotic twin. Pitfalls in amnionicity determination are (1) the lack of correlation between the number of yolk sacs and amnionicity and (2) failure to visualize the intertwin membrane because of technical issues.
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Affiliation(s)
- Jing Lu
- Laboratory of Research and Diagnosis of Gynecological Diseases of Xiamen City, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yuen Ha Ting
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong.
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Kutuk MS, Takmaz T, Bayram A, Ozturk S. Prenatal Sonographic Detection of Monochorionic Twins with Bipartite Placenta. Fetal Pediatr Pathol 2021; 40:685-690. [PMID: 32050832 DOI: 10.1080/15513815.2020.1725938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Determination of placentation and amnionicity is important for antenatal and intrapartum management in twin gestations. We present an typical monozygotic twin placenta and underscore the sonographic features and diagnostic pitfalls that may interfere with antenatal diagnosis. Case report: A 35-year-old G4P2 with a spontaneous pregnancy applied for routine second trimester anomaly screening. Upon prenatal ultrasonography at 20 weeks, an anatomically normal, same sex twin pregnancy was detected. A thin dividing membrane and a T-sign suggestive of a monochorionic diamniotic pregnancy were visualized. Antenatal follow-up was uneventful. Cesarean delivery was performed at 37 week. Postpartum examination revealed two distinct placental discs connected with each other through membranes. Microscopic examination of the membranes supported monochorionicity. Short Tandem Repeat Profile Analysis revealed identical pattern and confirmed monozygosity. Conclusion: Two separate placentas with a T-sign in same-sex twins should raise the suspicion of monozygosity, and should be followed accordingly.
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Affiliation(s)
- Mehmet Serdar Kutuk
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Taha Takmaz
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Arslan Bayram
- Department of Medical Genetics, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sule Ozturk
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
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Benn P, Rebarber A. Non-invasive prenatal testing in the management of twin pregnancies. Prenat Diagn 2021; 41:1233-1240. [PMID: 34170028 PMCID: PMC8518532 DOI: 10.1002/pd.5989] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/02/2022]
Abstract
Twin pregnancies are common and associated with pregnancy complications and adverse outcomes. Prenatal clinical management is intensive and has been hampered by inferior screening and less acceptable invasive testing. For aneuploidy screening, meta‐analyses show that non‐invasive prenatal testing (NIPT) through analysis of cell‐free DNA (cf‐DNA) is superior to serum and ultrasound‐based tests. The positive predictive value for NIPT is driven strongly by the discriminatory power of the assay and only secondarily by the prior risk. Uncertainties in a priori risks for aneuploidies in twin pregnancies are therefore of lesser importance with NIPT. Additional information on zygosity can be obtained using NIPT. Establishing zygosity can be helpful when chorionicity was not reliably established early in pregnancy or where the there is a concern for one versus two affected fetuses. In dizygotic twin pregnancies, individual fetal fractions can be measured to ensure that both values are satisfactory. Vanishing twins can be identified by NIPT. Although clinical utility of routinely detecting vanishing twins has not yet been demonstrated, there are individual cases where cf‐DNA analysis could be helpful in explaining unusual clinical or laboratory observations. We conclude that cf‐DNA analysis and ultrasound have synergistic roles in the management of multiple gestational pregnancies.
What's already known about this topic?
In singleton pregnancies, non‐invasive prenatal testing (NIPT) for fetal aneuploidy is more effective than conventional serum and ultrasound‐based screening tests. NIPT is more complex in dizygotic twin pregnancies due to the presence of two fetal genotypes. Overall fetal fraction is higher in twin pregnancies but the individual contribution for each fetus is lower.
What does this study add?
A review of cell‐free DNA testing in twin pregnancies. Individual fetal fractions in dizygotic twin pregnancies can be measured. Zygosity can be established using NIPT and this can be particularly useful when there are concerns about chorionicity or determining whether one versus two fetuses are affected. Vanishing twins can be detected through NIPT and this testing could be considered for some apparently singleton pregnancies with complications.
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Affiliation(s)
- Peter Benn
- Department of Genetics and Genome Sciences, UConn Health, Farmington, Connecticut, USA
| | - Andrei Rebarber
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Maternal Fetal Medicine, Englewood Hospital, Englewood, New Jersey, USA
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Woolnough B, Jackson A, Leveille MC, Gale J. Grossesse quadrichoriale quadriamniotique après un transfert d'embryon unique planifié. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:1227-1228. [PMID: 32475702 DOI: 10.1016/j.jogc.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bonnie Woolnough
- Département d'obstétrique et de gynécologie, Université d'Ottawa, Ottawa, Ont
| | - Aaron Jackson
- Département d'obstétrique et de gynécologie, Université d'Ottawa, Ottawa, Ont
| | | | - Jenna Gale
- Département d'obstétrique et de gynécologie, Université d'Ottawa, Ottawa, Ont
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Woolnough B, Jackson A, Leveille MC, Gale J. Quadrachorionic quadramnionic gestation following elective single embryo transfer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:1225-1226. [PMID: 32473984 DOI: 10.1016/j.jogc.2020.02.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Bonnie Woolnough
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | | | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
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Zhou AJ, Li L, Wang HM, Wang YY, Zhong LH, Dong TT, Wang XT, Li HY. Comparisons between two methods of multifetal pregnancy reduction in women with a dichorionic triamniotic triplet pregnancy. Taiwan J Obstet Gynecol 2020; 58:793-797. [PMID: 31759529 DOI: 10.1016/j.tjog.2019.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To compare the different pregnancy outcomes of women with a reduced dichorionic triamniotic (DCTA) triplet managed with radiofrequency ablation (RFA) or potassium chloride (KCL). MATERIALS AND METHODS This was a retrospective cohort study. We studied 30 women of DCTA triplets managed with RFA as well as 85 managed with KCL. We compared the mean neonatal birthweight, median gestational age and perinatal mortality of two groups. RESULTS The mean neonatal birthweight of children in RFA group was 2572.4 g (SD, 407.0), vs 2899.3 g (SD, 554.9) in KCL group (P < 0.001). The rate of low birth weight infants was 23 (42.6%) vs. 16 (18.0%), respectively, (p < 0.005). However, there was no statistically significant difference in the median gestational age of delivery, premature birth before 32&37 weeks' gestation, neonatal brain injury or successful pregnancy between two groups. (We define the successful pregnancy as the condition that at least one child survives for a specific woman, while the failed one as no child survives.) CONCLUSION: What we took it for granted was that pregnancy outcomes in women with a reduced DCTA triplet managed with RFA was riskier than with KCL, however, we proved that it is not accurate. For women with a reduced DCTA triplet, managed with RFA is not much riskier than with KCL. What's more, most women have two children survived in RFA group, while in KCL group, only one child survives for most women. This result may change the management alternative for those women with DCTA triplet pregnancies who choose reduction, especially for women who desire to have two surviving and healthy fetuses.
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Affiliation(s)
- Ai-Jun Zhou
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Hong-Mei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yan-Yun Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Li-Hang Zhong
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ting-Ting Dong
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xie-Tong Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, China; Maternal and Child Health Care of Shandong Province, Jinan, China.
| | - Hong-Yan Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
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Cai P, Ouyang Y, Gong F, Li X. Pregnancy outcomes of dichorionic triamniotic triplet pregnancies after in vitro fertilization-embryo transfer: multifoetal pregnancy reduction versus expectant management. BMC Pregnancy Childbirth 2020; 20:165. [PMID: 32178634 PMCID: PMC7077126 DOI: 10.1186/s12884-020-2815-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Trichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. However, data on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are lacking. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11–13+ 6 gestational weeks. Methods Two hundred ninety-eight patients with DCTA triplets conceived via IVF-ET between 2012 and 2016 were retrospectively analysed. DCTA triplets with three live foetuses were reduced to a MC singleton (group A) or MCDA twins (group B) or underwent expectant management (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11–13+ 6 gestational weeks. Pregnancy outcomes in the 3 groups were compared. Results Eighty-four DCTA pregnancies were reduced to MC singleton pregnancies, 149 were reduced to MCDA pregnancies, and 65 were managed expectantly. There were no significant differences among groups A, B, and C in miscarriage rate (8.3 vs. 7.4 vs. 10.8%, respectively) and live birth rate (90.5 vs. 85.2 vs. 83.1%, respectively) (P > 0.05). Group A had significantly lower rates of preterm birth (8.3 vs. 84.6%; odds ratio (OR) 0.017, 95% confidence interval (CI) 0.006–0.046) and low birth weight (LBW; 9.2 vs. 93.2%; OR 0.007, 95% CI 0.003–0.020) than group C (P < 0.001). Group B had significantly lower preterm birth (47.0 vs. 84.6%; OR 0.161, 95% CI 0.076–0.340) and LBW rates (58.7 vs. 93.2%; OR 0.103, 95% CI 0.053–0.200) than group C (P < 0.001). Group A had significantly lower preterm birth (8.3 vs. 47.0%; OR 0.103, 95% CI 0.044–0.237; P < 0.001), LBW (9.2 vs. 58.7%; OR 0.071, 95% CI 0.032–0.162; P < 0.001) and perinatal death rates (1.3 vs. 9.1%; OR 0.132, 95% CI 0.018–0.991; P = 0.021) than group B. Conclusion The MFPR of DCTA triplets to singleton or MCDA pregnancies was associated with better pregnancy outcomes compared to expectant management. DCTA triplets reduced to singleton pregnancies had better perinatal outcomes than DCTA triplets reduced to MCDA pregnancies.
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Affiliation(s)
- Pei Cai
- Institute of Reproductive and Stem Cell Engineering, Central South University, Changsha City, 410078, Hunan, China
| | - Yan Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, 410078, Hunan, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, Central South University, Changsha City, 410078, Hunan, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, 410078, Hunan, China
| | - Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, 410078, Hunan, China.
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Abgral M, Martinovic J, Bonnin A, Houllier M, Senat MV, Bouchghoul H. Two separate placental masses on ultrasound do not always indicate a dichorionic pregnancy. J Gynecol Obstet Hum Reprod 2020; 49:101694. [PMID: 31981627 DOI: 10.1016/j.jogoh.2020.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
Monochorionic pregnancies are associated with a higher risk of perinatal morbidity and mortality than dichorionic pregnancies. Early determination of chorionicity by an ultrasound exam between 11+0 and 14+0 weeks' gestation (WG) is essential for the subsequent management of twin pregnancies. The presence of the T-sign is the most specific sign for determination of monochorionicity. During the second trimester, the presence of two distinct placental masses has a lower specificity in determining the chorionicity. We report here two cases of a monochorionic pregnancy with a bipartite placenta, suggesting that a placenta with two separate masses, each with a distinct cord insertion is not always indicative of a dichorionic pregnancy.'
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Affiliation(s)
- Maëlig Abgral
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin - Bicêtre, France
| | - Jelena Martinovic
- Department of Fetal Pathology, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - Aurore Bonnin
- Department of Fetal Pathology, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - Marie Houllier
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin - Bicêtre, France
| | - Marie Victoire Senat
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin - Bicêtre, France
| | - Hanane Bouchghoul
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin - Bicêtre, France.
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Yu W, Lv Y, Yin S, Liu H, Li X, Liang B, Kong L, Liu C. Screening of fetal chromosomal aneuploidy diseases using noninvasive prenatal testing in twin pregnancies. Expert Rev Mol Diagn 2019; 19:189-196. [PMID: 30582381 DOI: 10.1080/14737159.2019.1562906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study was aimed to report the clinical characteristics of fetal chromosomal aneuploidy diseases using noninvasive prenatal testing (NIPT) in twin pregnancies and analyze the results in terms of chorionicity, conception, and fetal fraction. METHODS A total of 1160 women with twin pregnancies were recruited from 1 October 2015, to 1 August 2017. Next-generation sequencing technology was used to detect fetal aneuploidies, such as trisomy 21, trisomy 18, trisomy 13 and trisomy X. RESULTS Aneuploidy was detected using NIPT in 26 fetuses, among which 18 fetal aneuploidies occurred in only one fetus of the twins. The rate of aneuploidy was 1.3% for dichorionic diamniotic twins and 0.5% for monochorionic diamniotic twins, respectively. The rate of aneuploidy was 1.2% for spontaneous pregnancy group and 1.1% for assisted reproductive technologies group. CONCLUSION In this study, detection of trisomy 21, trisomy 18, trisomy 13, and X abnormality in twin pregnancies was confirmed to be accurate. The aneuploidies mostly occurred in only one fetus of the twins, and trisomy 21 was the most common type. The prenatal diagnostic standard for NIPT in singleton pregnancies could perform well in twin pregnancies, which means NIPT can be popularized as routine prenatal screening in twin pregnancies.
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Affiliation(s)
- Wenqian Yu
- a Department of Obestetrics and Gybecology , Shengjing Hospital of China Medical University, Liaoning Centre for Prenatal Diagnosis , Shenyang , China.,b Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province , Benxi , China
| | - Yuan Lv
- a Department of Obestetrics and Gybecology , Shengjing Hospital of China Medical University, Liaoning Centre for Prenatal Diagnosis , Shenyang , China.,b Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province , Benxi , China
| | - Shaowei Yin
- a Department of Obestetrics and Gybecology , Shengjing Hospital of China Medical University, Liaoning Centre for Prenatal Diagnosis , Shenyang , China.,b Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province , Benxi , China
| | - Hao Liu
- a Department of Obestetrics and Gybecology , Shengjing Hospital of China Medical University, Liaoning Centre for Prenatal Diagnosis , Shenyang , China.,b Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province , Benxi , China
| | - Xue Li
- a Department of Obestetrics and Gybecology , Shengjing Hospital of China Medical University, Liaoning Centre for Prenatal Diagnosis , Shenyang , China.,b Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province , Benxi , China
| | - Bo Liang
- c Department of research and development, Basecare Medical Device Co., Ltd. , Suzhou , China
| | - Lingyin Kong
- c Department of research and development, Basecare Medical Device Co., Ltd. , Suzhou , China
| | - Caixia Liu
- a Department of Obestetrics and Gybecology , Shengjing Hospital of China Medical University, Liaoning Centre for Prenatal Diagnosis , Shenyang , China.,b Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province , Benxi , China
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Lu J, Cheng YKY, Ting YH, Law KM, Leung TY. Pitfalls in assessing chorioamnionicity: novel observations and literature review. Am J Obstet Gynecol 2018; 219:242-254. [PMID: 29462630 DOI: 10.1016/j.ajog.2018.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
Abstract
Accurate diagnosis of chorioamnionicity in multiple pregnancies is the key to appropriate clinical management of multiple gestation. Although prenatal ultrasound assessment of chorioamnionicity is well established and highly accurate if performed in early pregnancy, exceptions and artifacts arise from anatomic variations in multiple pregnancies and unusual sonographic features do exist. We have summarized our own experiences and reports from the literature on these pitfalls as follows: (1) discordant fetal sex in monochorionic pregnancies due to sex chromosome abnormalities, genital malformation in 1 fetus, or dizygotic twins forming a monochorionic placenta; (2) separate placental masses in monochorionic pregnancies due to bipartite placenta; (3) false-negative and false-positive λ sign can arise for various reasons, and in partial monochorionic/dichorionic placentas both T and λ sign may co-exist; (4) intrauterine synechia appearing as a thick and echogenic intrauterine septum may lead to erroneous diagnosis of dichorionic twins; and (5) errors in ascertaining amnionicity by the visualization of thin intertwin amniotic membranes and the number of yolk sacs. The ultrasound techniques to reduce inaccuracy in prenatal determination of chorioamnionicity and the use of single nucleotide polymorphisms based on noninvasive prenatal test to determine zygosity are also reviewed.
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Fichera A, Pagani G, Stagnati V, Cascella S, Faiola S, Gaini C, Lanna M, Pasquini L, Raffaelli R, Stampalija T, Tommasini A, Prefumo F. Cervical-length measurement in mid-gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:614-620. [PMID: 28295801 DOI: 10.1002/uog.17464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the predictive value of sonographic cervical-length (CL) measurement in mid-gestation for spontaneous preterm birth (PTB) in asymptomatic triplet pregnancy. METHODS This was a retrospective study of asymptomatic triplet pregnancies followed at five Italian tertiary referral centers, between 2002 and 2015. CL was measured transvaginally between 18 and 24 weeks' gestation. Pregnancies with medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated by PTB were analyzed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. Performance of CL measurement in prediction of PTB < 28, < 30 and < 32 weeks of gestation was assessed. RESULTS A total of 120 triplet pregnancies were included in the final analysis. Median CL was 35 (interquartile range (IQR), 29-40) mm measured at a median gestational age of 20 + 2 (IQR, 20 + 0 to 23 + 4) weeks. Overall, 23 (19.2%), 17 (14.2%) and eight (6.7%) patients had a CL < 25, < 20 and < 15 mm, respectively. Spontaneous PTB < 32 weeks occurred in 41 (34.2%) cases, < 30 weeks in 23 (19.2%) and < 28 weeks in 12 (10%) cases. CL < 15 mm was significantly more frequent in the group of patients who delivered < 28 (P = 0.03) and < 30 (P = 0.01) weeks' gestation, compared with those who delivered after 28 and after 30 weeks, respectively, while CL < 20 mm was more common in triplet pregnancies with delivery < 32 weeks compared with those delivered ≥ 32 weeks (P = 0.03). Logistic regression analysis was possible only for PTB < 32 weeks due to the small number of cases that delivered < 30 and < 28 weeks. After adjustment for confounders, CL was not significantly associated with PTB < 32 weeks (adjusted odds ratio, 0.97; 95% CI, 0.94-1.01). CL measurement had an area under the receiver-operating characteristics curve of 0.41 (95% CI, 0.20-0.62), 0.41 (95% CI, 0.26-0.56) and 0.42 (95% CI, 0.31-0.54) for the prediction of spontaneous PTB < 28, < 30 and < 32 weeks, respectively. CONCLUSION CL assessed in mid-gestation is a poor predictor of PTB < 28, < 30 and < 32 weeks' gestation in asymptomatic triplet pregnancy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Fichera
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - G Pagani
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - V Stagnati
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - S Cascella
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - S Faiola
- Children's Hospital V. Buzzi, Milan, Italy
| | - C Gaini
- Department for Woman and Child Health, AOU Careggi, Florence, Italy
| | - M Lanna
- Children's Hospital V. Buzzi, Milan, Italy
| | - L Pasquini
- Department for Woman and Child Health, AOU Careggi, Florence, Italy
| | - R Raffaelli
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - T Stampalija
- Unit of Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - A Tommasini
- Unit of Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - F Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
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Smith J, Treadwell MC, Berman DR. Role of ultrasonography in the management of twin gestation. Int J Gynaecol Obstet 2018. [PMID: 29536536 DOI: 10.1002/ijgo.12483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Twins represent 1%-2% of all pregnancies, yet continue to account for a disproportionate share of neonatal adverse events including neonatal intensive care admission, morbidity, and mortality. Ultrasonography is central to the proper diagnosis of the type of twinning. Ideally, ultrasonography is performed before 14 weeks of gestation to determine chorionicity and amnionicity. Correct identification of the chorionicity in a twin pregnancy facilitates proper counseling and management of the gestation, including ultrasonography follow-up. Herein, the different types of twinning are reviewed, together with the implications for ultrasonography monitoring of each specific type of twin gestation.
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Affiliation(s)
- Jessica Smith
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Marjorie C Treadwell
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deborah R Berman
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Bracero LA, Huff C, Blitz MJ, Plata MJ, Seybold DJ, Broce M. Ultrasound and histological measurements of dividing membrane thickness in twin gestations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:470-475. [PMID: 27790818 DOI: 10.1002/uog.17337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/08/2016] [Accepted: 10/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine how prenatal ultrasound measurements of dividing membrane thickness correlate with postnatal histological measurements and chorionicity in twin gestations. METHODS This was a prospective, longitudinal cohort study of twin gestations. Dividing membrane thickness was measured by transabdominal ultrasound, with the insonation beam both parallel and perpendicular to the membrane, in the second or third trimester, depending on when care was established. Ultrasound examinations were performed every 4 weeks following initial assessment until delivery. Measurements of membrane thickness from the first ultrasound examination were compared with histological measurements after delivery. RESULTS A total of 45 twin pregnancies (32 dichorionic, 13 monochorionic) were included. Mean gestational age at initial ultrasound examination was 24.1 ± 7.3 weeks. Parallel ultrasound measurements of membrane thickness were 1.6 ± 0.8 mm for monochorionic and 2.5 ± 0.9 mm for dichorionic gestations (P = 0.001). Perpendicular ultrasound measurements were 1.6 ± 0.3 mm for monochorionic and 2.2 ± 0.8 mm for dichorionic gestations (P = 0.009). Inter- and intraobserver reliability of ultrasound measurements were 0.847 and 0.950, respectively. Parallel and perpendicular ultrasound measurements correlated better with each other (R = 0.807, P < 0.001) than with histological measurements of membrane thickness (Rparallel = 0.538, P < 0.001; Rperpendicular = 0.529, P < 0.001). Receiver-operating characteristics curve analyses to predict histological membrane thickness > 50th percentile resulted in an area under the curve (AUC) of 0.828 for parallel (P < 0.001) and 0.874 for perpendicular (P < 0.001) measurements with a cut-off value of 1.9 mm for both approaches. The AUCs for parallel and perpendicular measurements to predict dichorionicity were 0.892 (P < 0.001) and 0.823 (P < 0.001) with cut-off values of 1.9 and 1.8 mm, respectively. CONCLUSION Prenatal ultrasound measurement of twin dividing membrane thickness is positively correlated with postnatal histological measurement. Dichorionicity can be determined by a magnified dividing membrane thickness ≥ 1.9 mm. Measurements with the ultrasound beam parallel to the dividing membrane may be more accurate than perpendicular measurements. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L A Bracero
- Department of Obstetrics and Gynecology, West Virginia University Charleston Campus, Charleston, WV, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Southside Hospital, Bay Shore, NY, USA
| | - C Huff
- Department of Obstetrics and Gynecology, West Virginia University Charleston Campus, Charleston, WV, USA
| | - M J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - M J Plata
- Department of Pathology, Charleston Area Medical Center, Charleston, WV, USA
| | - D J Seybold
- Center for Health Services & Outcomes Research, Charleston Area Medical Center, Charleston, WV, USA
| | - M Broce
- Center for Health Services & Outcomes Research, Charleston Area Medical Center, Charleston, WV, USA
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Audibert F, Gagnon A. No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e347-e361. [DOI: 10.1016/j.jogc.2017.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Audibert F, Gagnon A. N o 262-Dépistage et diagnostic prénatals de l’aneuploïdie en ce qui concerne les grossesses gémellaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e329-e346. [DOI: 10.1016/j.jogc.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Murata S, Takano M, Kagawa Y, Fujiwara M, Sumie M, Nakata M. Twin-twin transfusion syndrome in a monozygotic pregnancy with obvious lambda sign in first-trimester ultrasound. Taiwan J Obstet Gynecol 2017; 55:904-906. [PMID: 28040148 DOI: 10.1016/j.tjog.2015.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 10/20/2022] Open
Affiliation(s)
- Susumu Murata
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama City, Okayama Prefecture, Japan.
| | - Mayumi Takano
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama City, Okayama Prefecture, Japan
| | - Yukiko Kagawa
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama City, Okayama Prefecture, Japan
| | - Michihisa Fujiwara
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama City, Okayama Prefecture, Japan
| | - Masahiro Sumie
- Department of Obstetrics, Fukuoka Children's Hospital, Fukuoka City, Fukuoka Prefecture, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama City, Okayama Prefecture, Japan
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Yuan T, Wang W, Li XL, Li CF, Li C, Gou WL, Han Z. Clinical characteristics of fetal and neonatal outcomes in twin pregnancy with preeclampsia in a retrospective case-control study: A STROBE-compliant article. Medicine (Baltimore) 2016; 95:e5199. [PMID: 27787375 PMCID: PMC5089104 DOI: 10.1097/md.0000000000005199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 12/14/2022] Open
Abstract
The aim of our study was to compare the clinical characteristics of fetal and neonatal outcomes in twin pregnancies between women with preeclampsia (PE) and those with normotension in a Chinese population.There were 143 preeclamptic women and 367 normotensive women with twin pregnancies included in this retrospective case-control study. The baseline characteristics and perinatal outcomes were collected and compared between the groups. Multiple logistic regression and linear regression were used to assess the correlations between PE and the outcomes.Significant increases were observed in the frequencies of preterm delivery (OR = 2.75, P < 0.001), iatrogenic preterm birth (OR = 3.52, P < 0.001), and IUGR (OR = 2.94, P = 0.001) in the PE group, and the PE group had more than a 2-fold risk of adverse neonatal outcomes. Preeclamptic twin neonates had lower birth weights (β = -147.34, P = 0.005; β = -169.47, P = 0.001). The comparison on the discordance of intertwin weight was not significantly different.Twin pregnancies with PE are associated with worse perinatal outcomes. The adverse outcomes of preeclamptic twin pregnancies may be associated with lower birth weights rather than the discordance of the intertwin weight, which requires further confirmation. The results may provide helpful references for better clinical assessments, evaluations of prognosis, and a deeper understanding of preeclamptic twin pregnancies.
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Affiliation(s)
- Ting Yuan
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi’an Jiaotong University College of Medicine
| | - Wei Wang
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi’an Jiaotong University College of Medicine
| | - Xue-Lan Li
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi’an Jiaotong University College of Medicine
| | - Chun-Fang Li
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi’an Jiaotong University College of Medicine
| | - Chao Li
- Department of Public Health, Xi’an Jiaotong University College of Medicine, Shaanxi, China
| | - Wen-Li Gou
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi’an Jiaotong University College of Medicine
| | - Zhen Han
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Xi’an Jiaotong University College of Medicine
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Panagiotopoulou O, Fouzas S, Sinopidis X, Mantagos SP, Dimitriou G, Karatza AA. Congenital heart disease in twins: The contribution of type of conception and chorionicity. Int J Cardiol 2016; 218:144-149. [PMID: 27232926 DOI: 10.1016/j.ijcard.2016.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increased incidence of congenital heart disease (CHD) has been reported in the offspring of monochorionic twin gestations. Assisted reproductive technology (ART), which is related to increased rates of twinning, has also been associated with higher risk of birth defects. We studied the incidence of CHD in a cohort of twins to clarify the contribution of type of conception and chorionicity. METHODS Data concerning 874 live-born twins of which at least one was admitted in our Neonatal Unit during 1995-2012 were analysed. Forty-five % (N=197) of the gestations resulted from ART (in vitro fertilisation or intracytoplasmic sperm insertion). RESULTS In the ART group 32/389 (8.2%) had CHD compared to 21/485 (4.3%) infants conceived naturally (OR 1.90, 95%CI 1.08-3.34, p=0.024). Spontaneous-conception gestations had higher incidence of monochorionic placentation (47/245 versus 4/197, p<0.001), and included younger mothers (29.1±5.2 versus 33.9±5.5years, p<0.001) who had higher parity (median 2 [range 1-7] versus 1 Pinborg (2005), Blondel and Kaminski (2002), Knopman et al. (2014), Kyvik and Derom (2006) ; p<0.001). Multivariable logistic regression analysis showed that ART (OR 2.60, 95% CI 1.24-5.45) and monochorionicity (OR 3.49, 95% CI 1.57-7.77) were significant determinants of CHD, independently of maternal age, parity, and the gender of the offspring. CONCLUSIONS We confirmed that monochorionic twins have increased risk of CHD and we documented a higher incidence of CHD in ART twins independently of chorionicity. We suggest improvement of echocardiographic skills of health care professionals involved in prenatal screening and foetal cardiology referral of ART dichorionic twins with suspicious findings at screening, in addition to all monochorionic gestations.
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Affiliation(s)
- Olga Panagiotopoulou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Sotirios Fouzas
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Xenophon Sinopidis
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Stefanos P Mantagos
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Gabriel Dimitriou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Ageliki A Karatza
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece.
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Peng R, Zhou Y, Xie HN, Zheng J, Xie YJ, Yang JB. MCDA twins with discordant malformations: submicroscopic chromosomal anomalies detected by chromosomal microarray analysis and clinical outcomes. Prenat Diagn 2016; 36:766-74. [PMID: 27315788 DOI: 10.1002/pd.4859] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/03/2016] [Accepted: 06/10/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Ruan Peng
- Department of Ultrasonic Medicine; Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Yi Zhou
- Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine; Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Ju Zheng
- Department of Ultrasonic Medicine; Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Ying-Jun Xie
- Department of Ultrasonic Medicine; Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Jian-Bo Yang
- Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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Maruotti G, Saccone G, Morlando M, Martinelli P. First-trimester ultrasound determination of chorionicity in twin gestations using the lambda sign: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2016; 202:66-70. [DOI: 10.1016/j.ejogrb.2016.04.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
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Wu D, Huang L, He Z, Huang X, Fang Q, Luo Y. Preeclampsia in twin pregnancies: association with selective intrauterine growth restriction. J Matern Fetal Neonatal Med 2015; 29:1967-71. [PMID: 26169709 DOI: 10.3109/14767058.2015.1070140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify the association between preeclampsia (PE) and selective intrauterine growth restriction (sIUGR) in twin pregnancies. METHODS This was a retrospective cohort study of 1004 twin pregnancies from 2008 to 2014. We specifically compared the incidence, clinical characteristics and outcomes of PE between sIUGR and normal-growth twin pregnancies. RESULTS PE occurred more frequently in sIUGR pregnancies [29.0% (51/176)] than in normal-growth twin pregnancies [13.1% (99/756), p < 0.001, adjusted odds ratio 3.29]. Among sIUGR, the incidence of PE was significantly higher in dichorionic (DC) pregnancies (37.5%, 30/80) than in monochorionic (MC) pregnancies (21.9%, 21/96). The rates of onset at <32 weeks (p = 0.045) and of severe PE (p = 0.025) were higher in sIUGR pregnancies with PE. The systolic blood pressure was also higher in sIUGR pregnancies with PE (152.6 ± 11.8 mmHg) than in normal-growth pregnancies with PE (148.0 ± 8.2 mmHg) (p = 0.042). Additionally, more sIUGR pregnancies were delivered at 32-36 weeks (p = 0.001), and fewer were delivered at ≥36 weeks (p < 0.001). Moreover, the prevalence of severe neonatal asphyxia was higher in sIUGR pregnancies with PE than in normal-growth pregnancies with PE (8.8% versus 2.5%, p = 0.020). CONCLUSIONS sIUGR is associated with increased odds of developing severe PE in twin pregnancies, leading to poorer perinatal outcomes.
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Affiliation(s)
- Dongcai Wu
- a Fetal Medicine Center, Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Linhuan Huang
- a Fetal Medicine Center, Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Zhiming He
- a Fetal Medicine Center, Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Xuan Huang
- a Fetal Medicine Center, Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Qun Fang
- a Fetal Medicine Center, Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Yanmin Luo
- a Fetal Medicine Center, Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , People's Republic of China
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Monozygotic twinning after assisted reproductive technologies: a case report of asymmetric development and incidence during 19 years in an international group of in vitro fertilization clinics. Fertil Steril 2015; 103:1185-9. [DOI: 10.1016/j.fertnstert.2015.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/19/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
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Blumenfeld YJ, Momirova V, Rouse DJ, Caritis SN, Sciscione A, Peaceman AM, Reddy UM, Varner MW, Malone FD, Iams JD, Mercer BM, Thorp JM, Sorokin Y, Carpenter MW, Lo J, Ramin SM, Harper M. Accuracy of sonographic chorionicity classification in twin gestations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2187-92. [PMID: 25425377 PMCID: PMC4246197 DOI: 10.7863/ultra.33.12.2187] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/31/2014] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. METHODS We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. RESULTS A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. CONCLUSIONS Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis.
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Affiliation(s)
- Yair J Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.).
| | - Valerija Momirova
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Steve N Caritis
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Alan M Peaceman
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Michael W Varner
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Fergal D Malone
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Jay D Iams
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - John M Thorp
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Marshall W Carpenter
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Julie Lo
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
| | - Susan M Ramin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California USA (Y.J.B.); George Washington University Biostatistics Center, Washington, DC USA (V.M.); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama USA (D.J.R.); University of Pittsburgh, Pittsburgh, Pennsylvania USA (S.N.C.); Drexel University, Philadelphia, Pennsylvania USA (A.C.S.); Northwestern University, Chicago, Illinois USA (A.M.P.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland USA (U.M.R.); University of Utah, Salt Lake City, Utah USA (M.W.V); Columbia University, New York, New York USA (F.D.M.); The Ohio State University, Columbus, Ohio USA (J.D.I); Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio USA (B.M.M); University of North Carolina, Chapel Hill, North Carolina USA (J.M.T.); Wayne State University, Detroit, Michigan USA (Y.S); Brown University, Providence, Rhode Island USA (M.W.C.); University of Texas Southwestern Medical Center, Dallas, Texas USA (J.L); University of Texas Health Science Center, Houston, Texas USA (S.M.R.); and Wake Forest University Health Sciences, Winston-Salem, North Carolina USA (M.H.)
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Down syndrome screening in assisted conception twins: an iatrogenic medical challenge. Obstet Gynecol Surv 2014; 68:825-34. [PMID: 24193195 DOI: 10.1097/ogx.0000000000000001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to provide a critical analysis of the impact of assisted conception on prenatal screening for Down syndrome (DS) in twin pregnancies and the value of various screening modalities for early detection of anomalies. METHODS The literature was searched using PubMed and the Cochrane Library focusing on prenatal screening and antenatal care of assisted-conception twin pregnancies. RESULTS Serum screening alone is of limited value in detecting aneuploid twins, because the unaffected cotwin can "mask" the abnormal serum results of an affected one. In addition, this test can designate the pregnancy as at high risk but not identify the affected fetus. Nuchal translucency (NT) screening is the best available modality and a highly effective screening method for twin pregnancies. Among twins, NT alone has a 69% DS detection rate, first-trimester combined NT and serum biochemistry has a 72% DS detection rate, and an integrated screen will have an 80% DS detection rate at a 5% FPR. The data in the literature concerning the effect of assisted conception on maternal serum screening markers in twin pregnancies are scarce. CONCLUSIONS Down syndrome screening in assisted-conception twins presents clinical and technical challenges. Therefore, assisted-conception twins need close monitoring from conception to delivery, by a practitioner familiar with the available screening modalities and their relative accuracy.
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Gagnon A, Audibert F. Prenatal screening and diagnosis of aneuploidy in multiple pregnancies. Best Pract Res Clin Obstet Gynaecol 2013; 28:285-94. [PMID: 24485166 DOI: 10.1016/j.bpobgyn.2013.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/29/2022]
Abstract
Prenatal screening for aneuploidy has changed significantly over the last 30 years, from being age-based to maternal serum and ultrasound based techniques. Multiple pregnancies present particular challenges with regards to screening as serum-based screening techniques are influenced by all feti while ultrasound-based techniques can be fetus specific. Tests currently available tend to not perform as well in multiple compared to singleton pregnancies. Considerations must be given to these variations when discussing and performing screening for aneuploidy in this situation. Prenatal invasive diagnosis techniques in multiple pregnancies bring their own challenges from a technical and counselling point of view, in particular with regards to sampling error, mapping and assignment of results and management of abnormal results. This review addresses these particular challenges and provides information to facilitate care.
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Affiliation(s)
- Alain Gagnon
- University of British Columbia, Vancouver, British Columbia, Canada.
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Moise KY, Kugler L, Jones T. Contemporary Management of Complicated Monochorionic Twins. J Obstet Gynecol Neonatal Nurs 2012; 41:434-44; quiz 445-6. [DOI: 10.1111/j.1552-6909.2012.01355.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Karen Y Moise
- Texas Fetal Center, University of Texas Health Science Center, Children's Memorial Hermann Hospital, Houston, TX 77030, USA.
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Linduska N, Messerschmidt A, Dekan S, Brugger PC, Weber M, Pollak A, Prayer D. Placental magnetic resonance imaging in monochorionic twin pregnancies. J Matern Fetal Neonatal Med 2011; 25:1419-22. [PMID: 22070182 DOI: 10.3109/14767058.2011.636106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic pregnancies. Placental hydrops might be a marker for TTTS. The purpose of this study was to evaluate whether differences in the placental parenchyma due to TTTS can be seen with fetal MRI. METHODS In a retrospective study, 34 monochorionic pregnancies were investigated on a 1.5 Tesla MR. Seventeen pregnancies were affected by TTTS, and 17 showed no clinical signs of TTTS. Placental maturation and vascular pathologies, as well as the extent of the placental findings and allocation of placental tissue to each twin, were investigated. Placental findings were reported for origin, size, maturation, and placental thickness, and were correlated with the presence of TTTS. RESULTS All placentas affected by TTTS showed abnormal maturation on MR scans, but only 64.7% of the non-TTTS group (p = 0.018). Vascular placental pathologies did not differ significantly between the TTTS and non-TTTS group. CONCLUSIONS MR-signs of placental maturity in monochorionic twin pregnancies may indicate a lower risk of development of TTTS.
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Affiliation(s)
- Nina Linduska
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Wien, Austria.
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Audibert F, Gagnon A, Douglas Wilson R, Audibert F, Blight C, Brock JA, Cartier L, Désilets VA, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M, Senikas V, Langlois S, Chitayat D, Désilets VA, Geraghty MT, Marcadier J, Nelson TN, Skidmore D, Siu V, Tihy F. Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011. [DOI: 10.1016/s1701-2163(16)34963-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Skiadas CC, Missmer SA, Benson CB, Acker D, Racowsky C. Impact of selective reduction of the monochorionic pair in in vitro fertilization triplet pregnancies on gestational length. Fertil Steril 2010; 94:2930-1. [PMID: 20646687 DOI: 10.1016/j.fertnstert.2010.05.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 05/11/2010] [Accepted: 05/11/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Christine C Skiadas
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Skiadas CC, Missmer SA, Benson CB, Acker D, Racowsky C. Spontaneous reduction before 12 weeks' gestation and selective reduction similarly extend time to delivery in in vitro fertilization of trichorionic-triamniotic triplets. Fertil Steril 2010; 95:596-9. [PMID: 20655523 DOI: 10.1016/j.fertnstert.2010.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 06/02/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the prevalence and the relative benefits conferred by selective and spontaneous reduction of one or more fetuses in trichorionic triamniotic triplet pregnancies on time to delivery. DESIGN Retrospective cohort study. SETTING Academic medical center. PATIENT(S) IVF patients with trichorionic triamniotic triplets between January 1998 and December 2007. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Gestational length at time of delivery. RESULT(S) Selective reduction to twins was used in 87 of the 153 (56.9%) triplet pregnancies that did not spontaneously reduce prior to <12 weeks, and was associated with longer gestation (13.9 days) with a fourfold greater likelihood of delivery at ≥ 34 weeks' gestation (odds ratio [OR], 4.3; 95% confidence interval [CI] = 2.2-8.6), compared with pregnancies not undergoing selective reduction. Compared with ongoing triplets, spontaneous reduction at <12 weeks' gestation (28 cases) was associated with longer gestation (13.7 days) and significantly greater likelihood delivering at or after 34 weeks' gestation (OR, 3.7; 95% CI, 1.4-9.9). CONCLUSION(S) Selective reduction of one fetus was used in 56.9% of patients in this population. Early spontaneous reduction (<12 weeks) and selective reduction to twins each conferred similar benefits by extending time to delivery and increasing the likelihood of delivery at or after 34 weeks' gestation.
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Affiliation(s)
- Christine C Skiadas
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Koster MPH, Wortelboer EJ, Stoutenbeek P, Visser GHA, Schielen PCJI. Distributions of current and new first-trimester Down syndrome screening markers in twin pregnancies. Prenat Diagn 2010; 30:413-7. [DOI: 10.1002/pd.2483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Elsayes KM, Trout AT, Friedkin AM, Liu PS, Bude RO, Platt JF, Menias CO. Imaging of the Placenta: A Multimodality Pictorial Review. Radiographics 2009; 29:1371-91. [DOI: 10.1148/rg.295085242] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
There have been significant advances in our understanding of the aetiology and management of disorders specific to Monochorionic Diamniotic (MCDA) twin pregnancies like Twin-Twin Transfusion Syndrome (TTTS) and Twin Reversed Arterial Perfusion (TRAP) but there is paucity of data about the management of uncomplicated MCDA twins pregnancies. It is accepted that even in the absence of specific complications, these pregnancies are associated with increased perinatal morbidity & mortality. The aim of this review is to gather evidence regarding the management of seemingly uncomplicated monochorionic diamniotic pregnancies.
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Affiliation(s)
- M Nair
- Department of Obstetrics and Gynaecology, Wythenshawe Hospital, South Manchester University Hospitals, UK.
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Ekelund CK, Skibsted L, Søgaard K, Main KM, Dziegiel MH, Schwartz M, Moeller N, Roos L, Tabor A. Dizygotic monochorionic twin pregnancy conceived following intracytoplasmic sperm injection treatment and complicated by twin-twin transfusion syndrome and blood chimerism. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:832-834. [PMID: 18956441 DOI: 10.1002/uog.6221] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of a dizygotic monochorionic twin pregnancy preceded by intracytoplasmic sperm injection treatment including assisted hatching. On ultrasound examination at 25 weeks' gestation the twins, which had been assumed to be monochorionic, were found to be of different sexes. Karyotyping and zygocity determination were performed on amniotic fluid and showed the twins to be dizygotic with normal female and male karyotypes. There were clinical and sonographic signs of twin-twin transfusion syndrome (TTTS), and Cesarean delivery was performed at 32 weeks' gestation. At birth the twins were phenotypically a normal male and a normal female. Histology of the placenta showed it to be monochorionic diamniotic. Blood chimerism was found postnatally as both infants had the karyotypes 46,XX[13]/46,XY[17]. Chimerism was not found in cells from a buccal swab at 6 months of age. This is one of only a few reported cases of dizygotic monochorionic twins. Nearly all of these cases have been conceived after assisted reproductive technology procedures. It is of clinical importance to be aware of this rare phenomenon in relation to TTTS, prenatal screening and parental counseling.
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Affiliation(s)
- C K Ekelund
- Department of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Salomon LJ, Ville Y. Syndrome transfuseur-transfusé : physiopathologie, diagnostic et traitement chirurgical. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2008. [DOI: 10.1016/s0001-4079(19)32664-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zech NH, Wisser J, Natalucci G, Riegel M, Baumer A, Schinzel A. Monochorionic-diamniotic twins discordant in gender from a naturally conceived pregnancy through postzygotic sex chromosome loss in a 47,XXY zygote. Prenat Diagn 2008; 28:759-63. [DOI: 10.1002/pd.2031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abramowicz JS, Sheiner E. Ultrasound of the placenta: a systematic approach. Part I: Imaging. Placenta 2008; 29:225-40. [PMID: 18262643 DOI: 10.1016/j.placenta.2007.12.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/17/2007] [Accepted: 12/20/2007] [Indexed: 11/28/2022]
Abstract
Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities.
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Affiliation(s)
- J S Abramowicz
- Department of Obstetrics and Gynecology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Quarello E, Roume J, Molho M, Gorincour G, Saada J, Simon I, Bernard JP, Ville Y. Twins discordant for fetal skeletal abnormalities: a natural confrontation between the two siblings. Prenat Diagn 2008; 28:21-7. [DOI: 10.1002/pd.1896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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LI H, MENG T, SHANG T, GUAN YP, ZHOU WW, YANG G, BI LH. Fetal echocardiographic screening in twins for congenital heart diseases. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200708020-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
First-trimester risk assessment for fetal aneuploidy using nuchal translucency (NT) measurement is rapidly gaining popularity in the United States. In combination with maternal serum markers in the first trimester, the screening performance is exceptionally good, with detection rates of more than 80% at a screen positive rate of 5%. Recently, the method has been validated for screening for Down syndrome and other aneuploidies in multicenter trials in the United States and elsewhere. Compliance with established criteria for measurement of the NT is essential to achieve uniform reliability and high screening test sensitivity. There is an international consensus about the importance of specific training in the NT examination, conformity to standards of NT measurement, and regular audit for quality assurance. In the United States, the Nuchal Translucency Quality Review program has been developed to administer credentialing and quality review for registered practitioners. The Nuchal Translucency Quality Review credentials signify the proficiency of the sonographer or sonologist in NT measurement and participation in a regular quality assurance audit. We encourage accreditation of clinical sites offering first-trimester risk assessment to ensure the highest quality care.
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Affiliation(s)
- Celeste Sheppard
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA.
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Nisenblat V, Leibovitz Z, Paz B, Shapiro I, Degani S, Ohel G. Dizygotic twin pregnancy discordant for sirenomelia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:97-103. [PMID: 17182714 DOI: 10.7863/jum.2007.26.1.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Vicki Nisenblat
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
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46
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Current awareness in prenatal diagnosis. Prenat Diagn 2006; 26:94-9. [PMID: 16475249 DOI: 10.1002/pd.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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