Korean J Radiol.  2003 Mar;4(1):54-60. 10.3348/kjr.2003.4.1.54.

Complications Arising in Twin Pregnancy: Findings of Prenatal Ultrasonography

• Kim JA
• Cho JY
• Lee YH
• Song MJ
• Min JY
• Lee HJ
• Han BH
• Lee KS
• Cho BJ
• Chun YK

• KMID: 754043
• DOI: http://doi.org/10.3348/kjr.2003.4.1.54

Abstract

Multifetal gestations are high-risk pregnancies involving higher perinatal morbidity and mortality, and are subject to unique complications including twin oligohydramnios-polyhydramnios sequence, twin-to-twin transfusion syndrome, acardiac twins, conjoined twins, co-twin demise, and heterotopic pregnancies. The purpose of this study is to describe the prenatal ultrasonographic and pathologic findings of these complications.

Keyword

Twins; Twins, abnormalities; Ultrasound

Figure

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  Fig. 1 Prenatal ultrasonographic findings of twin oligohydramnios-polyhydramnios sequence in a monochorionic pregnancy. A. Ultrasonogram obtained at gestational age 22 weeks shows a 20-week sized stuck twin (B) with severe oligohydramnios and a larger 22-week twin (A) with polyhydramnios (arrowheads: thin inter-twin membrane). B, C. Cord insertions of fetus A (B) and fetus B (C) are separated.

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  Fig. 2 Doppler sonographic findings of twin-to-twin transfusion syndrome in a monochorionic diamniotic twin pregnancy. A. Ultrasonogram obtained at gestational age 21 weeks shows significant discrepancy in fetal sizes. Fetus A is larger than fetus B by more than 2 SD. B. Color Doppler sonogram demonstrates approximate insertions (arrows) of two umbilical cords in a single placenta. C, D. Umbilical arterial Doppler sonogram of the smaller fetus (C) depicts increased vascular resistance and absent diastolic flow, while that of the larger fetus (D) shows normal diastolic flow.

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  Fig. 3 Sonographic diagnosis of acardiac twins in a monochorionic diamniotic pregnancy. A. Ultrasonogram obtained at gestational age 19 weeks shows significant discrepancy in fetal sizes. The absence of a heart and diffuse soft tissue edema are demonstrated in the larger fetus B (arrow). B. Fetus B has no head (short arrow) and no heart, though tudimentary bony upper extremities (long arrows) are visible. A multiseptated cystic mass suggesting a large cystic hygroma is associated with the acardiac fetus. C. Color Doppler sonogram demonstrates interfetal anastomoses (arrow) of umbilical vessels between the twins. D. Duplex sonogram verifies that in the umbilical artery (UA) of the acardiac fetus B, flow is reversed. E. Placental pathology demonstrates anastomoses (arrow) of the umbilical vessels between the twins in the monochorionic placenta. Dye injection through the umbilical vessels verified interfetal artery-to-artery and vein-to-vein anastomoses (not shown).

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  Fig. 4 Ultrasonographic and autopsy findings of conjoined twins. A. Ultrasonogram obtained at gestational age 21 weeks depicts fused cranium and cerebra. B. Fused cranium and anterior chest with two "V"-shaped spines (arrows) are apparent. C. Fused anterior abdomen with two ischia (ISC) is noted. D, E. Specimen radiographs (D) and autopsy specimen (E) demonstrate conjoined twins with fused cranium, anterior chest and abdomen (craniothoracoomphalopagus).

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  Fig. 5 Sonographic findings of monochorionic diamniotic twins with co-twin demise. A. Ultrasonogram obtained at gestational age 14 weeks shows a fairly-well visualized (short arrow) but preserved (arrowheads) thin intertwin membrane with a single placenta, and intrauterine fetal death of one fetus with diffuse soft tissue edema (arrows). B. Ultrasonogram obtained at gestational age 23 weeks depicts an enlarged umbilical cord (arrow) in the surviving fetus. C. Cardiomegaly with thickened biventricular walls (arrows) developed in the surviving fetus.

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  Fig. 6 Ultrasonographic findings of a cornual heterotopic pregnancy. A. Ultrasonogram obtained at gestational age 7 weeks shows a gestational sac (black arrow) with an embryo (arrowhead) within the uterine cavity. B. In the cornual portion of the uterus, a coexisting gestational sac (arrows) with an embryo (arrowhead) is visible.

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