Ultraschall Med 2021; 42(03): 246-269
DOI: 10.1055/a-1344-4812
Continuing Medical Education

Twin pregnancies

Zwillingsschwangerschaften
Department of Obstetrics, University Hospital Zürich and University of Zurich, Zurich, Switzerland
› Author Affiliations

Abstract

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

Zusammenfassung

Zwillingsschwangerschaften, die zu 2–3 % aller Geburten führen, sind ein Hochrisikokollektiv, das einer besonderen Betreuung bedarf. Die korrekte Datierung der Schwangerschaft mit Bestimmung der Chorionizität und Amnionizität im ersten Trimester (≤ 13 + 6 SSW) ist eine wichtige Voraussetzung für die weitere Schwangerschaftsbetreuung. Im ersten Trimester beinhaltet die sonografische Risikobeurteilung monochorialer Schwangerschaften die Evaluation der Scheitel-Steiß-Längen- und Nackentransparenz-Differenzen und der Fruchtwasser (FW) -Diskrepanz. Bei 16 SSW können bei monochorialen Zwillingen eine FW-Diskrepanz, Abdomenumfangsdifferenz und Insertio velamentosa auf ein erhöhtes Komplikationsrisiko hinweisen. Bei 20 SSW soll allen Zwillingsschwangerschaften ein detailliertes Organscreening zum Ausschluss von Fehlbildungen und eine Zervixlängenmessung als Screening für ein erhöhtes Frühgeburtsrisiko (Cut-off < 25 mm) angeboten werden. Anschließend sollte bei unkomplizierten dichorialen Zwillingen alle 4 Wochen eine US-Untersuchung zur Wachstums- und Fruchtwasserbeurteilung folgen. Bei einer Zwillings-Gewichtsdiskrepanz > 20 % liegt ein erhöhtes Komplikationsrisiko vor. Monochoriale Zwillinge sollten wegen der Risiken eines fetofetalen Transfusionssyndroms (FFTS), einer Twin-Anemia-Polycythemia-Sequence (TAPS) oder einer selektiven Wachstumsretardierung (sFGR) US- und Doppler-Kontrollen ab 16 SSW mindestens 2-wöchentlich erhalten. Eine sFGR bei monochorialen Zwillingen wird je nach enddiastolischem Flussmuster in der Nabelschnurarterie in 3 Typen eingeteilt. Die Definition eines FFTS beinhaltet ein Oligohydramnion (tiefstes FW-Depot < 2 cm) beim einen und Polyhydramnion (tiefstes FW-Depot > 8 cm) beim anderen Zwilling, während für die Diagnose eines TAPS die delta-MCA-PV > 0,5MoM liegen muss.



Publication History

Article published online:
23 February 2021

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