Multifetal pregnancy

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Ultrasound images of multifetal pregnancy:

Sextuplets

Multifetal reduction

The twin peak sign of Diamnioitic Dichorionic twins

Conjoined twins (Siamese twins)- a case of thoraco-omphalopagus

Acardiac twin or severe TTTS (severe twin to twin transfusion syndrome)

 

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Sextuplets:

ultrasound image of multiple pregnancy (sextuplets)

This ultrasound image shows 6 separate gestation sacs with embryos within them. Image courtesy of Dr. Megala Devi, Chennai, India.

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Multifetal reduction:

 

ultrasound image shows multifetal rduction     reduction of fetuses to twins

The above ultrasound images reveal reduction of early quadruplet gestation by ablation (using KCl) of 2 fetuses, converting it successfully to a twin gestation (image on right half). Images courtesy of Dr. Udaya Kumar, Chennai, India.

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The twin peak sign of Diamnioitic Dichorionic twins:

ultrasound image of twin peak sign     twin peak sign of dichorionic twins

These ultrasound images demonstrate twin pregnancy at 13 weeks gestation. The intertwin membrane reveals that this is a diamniotic twin pregnancy. Also note the presence of the triangular wedge of placental tissue projecting into the intertwin membrane. This is called the Twin peak sign or the lambda sign which clearly suggests a Dichorionic twin pregnancy. Ultrasound images of Dichorionic gestation courtesy of Dr. Mohammed Sheriff, Tanzania.

 

Reference: http://radiology.rsnajnls.org/cgi/content/full/220/1/68 (free article and images).

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Conjoined twins (Siamese twins)- a case of thoraco-omphalopagus:

Shared common heart:                                                    Showing the shared heart:

shared heart in conjoined twins   common heart seen

Zoomed view of shared heart:                                            Separate heads seen: face of conjoined fetuses

shared heart in thoraco-omphalopagus   the faces of the fetuses seen separately

Separate urinary bladders (UB) and shared liver:              Snapshot of the conjoined twins after delivery:

fused abdomen seen   snapshot of specimen after delivery

Some more snaps of same case:                       

thoraco-omphalopagus photo   conjoined twins fused at chest and abdomen

Conjoined twin fetuses were detected on ultrasound imaging during routine obstetric sonography. The ultrasound images above show a shared heart with markedly altered anatomy. The fetal abdomen were also fused to each other (see post natal snaps) with shared livers. The urinary bladders (UB) were seen to be separate. These ultrasound findings suggest thoraco-omphalopagus or fusion of the thorax and abdomen. This case study is courtesy of Dr. Vikas Shukla, MD, India.

Reference: http://www.sonoworld.com/Fetus/page.php?id=315

http://sites.google.com/site/drjoea/obstetric-2

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Acardiac twin or severe TTTS (severe twin to twin transfusion syndrome):

abnormal acardiac twin- ultrasound image    ultrasound image- TTTS 

3D ultrasound image- acardiac twin    3D ultrasound image acardiac twin 

This 2nd trimester twin pregnancy (diamniotic- monochorionic) shows a viable fetus (normal fetus) with no evidence of associated congenital anomalies, and the twin fetus with severe congenital anomalies (non viable fetus). The non viable fetus shows very little normal tissue, but for part of a rudimentary spine, surrounded edematous soft tissue (fetal hydrops). There is clearly evident formation of inter-twin membrane between the two fetuses. The non viable twin is also called the acardiac twin because it has no identifiable cardiac structures; besides the fetal cranium or thorax are also not identified. These ultrasound images suggestive of a non viable fetus with severe anomalies, the most probable diagnosis being acardiac twin, a severe form of twin to twin transfusion syndrome (TTTS), or possible TRAP or twin reversed arterial perfusion syndrome. In this condition, blood flows via an ARTERIO-ARTERIAL-ANASTOMOSIS (AAA) on the placenta; this deoxygentated blood is carried to the non viable, and extremely abnormal twin (the recipient), from the donor twin, from its umbilical artery. This phenomenon and transformation of the non viable or recipient twin to the acardiac twin is called the TRAP sequence or Twin Reversed Arterial Perfusion syndrome. Images of acardiac/ non viable twin are courtesy of Dr. Ravi Kadasne, MD, UAE.   

References: http://www.sonoworld.com/fetus/page.aspx?id=308 (article on acardiac twins)

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  This page was last edited on: Tuesday January 03, 2012 03:21 PM  

Copyright ©   2007- All rights reserved- www.ultrasound-images.com Dr. Joe Antony, MD, Cochin- 20, India.

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