Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-mggfc Total loading time: 0 Render date: 2025-02-17T16:23:56.488Z Has data issue: false hasContentIssue false

Chapter 5 - Gestational Dating in Multiple Pregnancy

Published online by Cambridge University Press:  11 October 2022

By
Pierre Macé ,
Houman Mahallati  and
Laurent J. Salomon
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

Dating of the pregnancy is one of the main aims of first trimester ultrasound in twin pregnancies. The main objective of dating in multiple pregnancies is to make ultrasound examinations later in pregnancy more effective in the screening and management of complications either specific to, or more frequent in, these pregnancies. The dating of twin pregnancies should ideally be based on that of singletons and should be performed when the crown-rump length (CRL) measurement is between 45 and 84 mm (i.e. 11+0 to 13+6 weeks of gestation) using the same reference chart, at the time of the routine 1st trimester ultrasound scan. If the woman presents after 14 weeks of GA with a CRL measurement above 84 mm, the dating of pregnancy should be based on the head circumference measurement. One of the recurrent questions is the choice of the fetus upon which to base dating, especially when there is a significant difference between the size of the two twins. The recent ISUOG guidelines on the role of ultrasound in twin pregnancies have outlined the most common practice: the larger CRL should be used for pregnancy dating as it may protect against overlooking the diagnosis of a subsequent selective IUGR of the smaller twin. As is the case for singleton pregnancies, twin pregnancies conceived via ART should be dated using the oocyte retrieval date or the embryonic age from fertilization.

Keywords

Gestational AgeCrown-rump lengthDiscrepancySelective Intra Uterine Growth Restriction
Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 48 - 53
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Whitworth, M, Bricker, L, Mullan, C. Ultrasound for fetal assessment in early pregnancy. Cochrane Pregnancy and Childbirth Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2015 Jul 14 [cited 2019 Apr 11]. http://doi.wiley.com/10.1002/14651858.CD007058.pub3CrossRefGoogle Scholar
ISUOG Practice Guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound in Obstetrics & Gynecology 2013 Jan;41(1):102–13.Google Scholar
Salomon, LJ, Cavicchioni, O, Bernard, JP, Duyme, M, Ville, Y. Growth discrepancy in twins in the first trimester of pregnancy. Ultrasound in Obstetrics & Gynecology 2005;26(5):512–26.CrossRefGoogle ScholarPubMed
Dias, T, Mahsud‐Dornan, S, Thilaganathan, B, Papageorghiou, A, Bhide, A. First-trimester ultrasound dating of twin pregnancy: are singleton charts reliable? BJOG 2010;117(8):979–84.Google Scholar
Khalil, A, Rodgers, M, Baschat, A, Bhide, A, Gratacos, E, Hecher, K et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound in Obstetrics & Gynecology 2016;47(2):247–63.CrossRefGoogle ScholarPubMed
Sebire, NJ, D’Ercole, C, Soares, W, Nayar, R, Nicolaides, KH. Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies. Obstet Gynecol 1998 Jan;91(1):82–5.CrossRefGoogle ScholarPubMed
Chaudhuri, K, Su, L-L, Wong, P-C, Chan, Y-H, Choolani, MA, Chia, D et al. Determination of gestational age in twin pregnancy: which fetal crown–rump length should be used? Gestational dating in twins. Journal of Obstetrics and Gynaecology Research 2013 Apr;39(4):761–5.CrossRefGoogle Scholar
Litwinska, E, Syngelaki, A, Cimpoca, B, Sapantzoglou, I, Nicolaides, KH. Intertwin discordance in fetal size at 11–13 weeks’ gestation and pregnancy outcome. Ultrasound in Obstetrics & Gynecology 2020 Feb;55(2):189–97. https://obgyn-onlinelibrary-wiley-com.lama.univ-amu.fr/doi/10.1002/uog.21923CrossRefGoogle ScholarPubMed
Robinson, HP, Fleming, JEE. A critical evaluation of sonar ‘crown–rump length’ measurements. Br J Obstet Gynaecol 1975 Sep;82(9):702–10.CrossRefGoogle ScholarPubMed
Kalish, RB, Chasen, ST, Gupta, M, Sharma, G, Perni, SC, Chervenak, FA. First trimester prediction of growth discordance in twin gestations. Am J Obstet Gynecol 2003 Sep;189(3):706–9.CrossRefGoogle ScholarPubMed
D’Antonio, F, Khalil, A, Pagani, G, Papageorghiou, AT, Bhide, A, Thilaganathan, B. Crown–rump length discordance and adverse perinatal outcome in twin pregnancies: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology 2014;44(2):138–46.Google ScholarPubMed
Mackie, FL, Hall, MJ, Morris, RK, Kilby, MD. Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis. American Journal of Obstetrics and Gynecology 2018 Nov;219(5):436–46.Google Scholar
Stagnati, V, Zanardini, C, Fichera, A, Pagani, G, Quintero, RA, Bellocco, R et al. Early prediction of twin-to-twin transfusion syndrome: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology 2017 May;49(5):573–82.CrossRefGoogle ScholarPubMed
Memmo, A, Dias, T, Mahsud‐Dornan, S, Papageorghiou, AT, Bhide, A, Thilaganathan, B. Prediction of selective fetal growth restriction and twin-to-twin transfusion syndrome in monochorionic twins.BJOG 2012;119(4):417–21.Google Scholar
Papageorghiou, AT, Kemp, B, Stones, W, Ohuma, EO, Kennedy, SH, Purwar, M et al. Ultrasound-based gestational-age estimation in late pregnancy. Ultrasound Obstet Gynecol 2016 Dec 1;48(6):719–26.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×