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. 2025 Jun 27:27:100414.
doi: 10.1016/j.eurox.2025.100414. eCollection 2025 Sep.

Clinical guidance VVOG: Antenatal care for twin pregnancies

Senna van der Heijden  1 , Noortje van Oostrum  2 , Roxanne Van Nuland  3 , Magali Verheecke  4 , Liesbeth Lewi  5
Affiliations

Clinical guidance VVOG: Antenatal care for twin pregnancies

Senna van der Heijden et al. Eur J Obstet Gynecol Reprod Biol X. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Placenta of uncomplicated monochorionic diamniotic twins born at 36 weeks after dye injection demonstrating the different blood vessel connections. The amnion and intertwinseptum were removed
Fig. 2
Fig. 2
Ultrasound image of dichorionic twins at 12 weeks. The intertwinseptum consists of a thick chorionic layer with two thin amniotic membranes (amnion-chorion-amnion) along both sides. The chorionic layer inserts at the level of the placenta as a "full lambda" sign
Fig. 3
Fig. 3
Image of monochorionic diamniotic twins at 13 weeks. The intertwinseptum consists only of two thin amniotic membranes (amnion-amnion) that inserts as an "empty lambda" sign
Fig. 4
Fig. 4
Image of dichorionic twins at 9 weeks. There are two separate gestational sacs and each fetus and yolk sac is in a separate exocoelomic cavity
Fig. 5
Fig. 5
Ultrasound image of monochorionic twins at 10 weeks. There is one gestational sac and a common exocoelomic cavity containing both fetuses and yolk sacs
Fig. 6
Fig. 6
Ultrasound image of monoamniotic twins at 13 weeks. Both fetuses are in a common amniotic sac with umbilical cords already visibly entangled
Fig. 7
Fig. 7
Schematic for the ultrasound follow-up of di- and monochorionic twins
Fig. 8
Fig. 8
Twin-to-twin transfusion syndrome is characterized by a severe difference in amniotic fluid with a deepest vertical amniotic fluid loge less than 2 cm in the donor who has a small or empty bladder and more than 8 cm (before 20 weeks) or more than 10 cm (after 20 weeks) in the receptor who has a distended bladder
Fig. 9
Fig. 9
Twin anemia polycytemia sequence is characterized by a severe difference in hemoglobin with an increased peak velocity in the middle cerebral artery (MCA PSV) of 1.5 MoM (multiples of the median) or more in the anemic donor and 0.8 MoM or less in the polycytemic receptor. A difference of 1 MoM or more is also considered diagnostic. Often there is also an echogenicity difference of the placenta and the receptor has a dark congested liver in which the small venules light up ("starry sky")
See this image and copyright information in PMC

References

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