This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. State the ideal time to date a twin pregnancy using ultrasound
2. Discuss monitoring of twin pregnancies using ultrasound
Estimated time to complete activity: 0.5 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 7/1/2019 through 7/1/2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours.Read Disclaimer & Fine Print
Twin pregnancies are followed more closely than singleton pregnancies due to higher risk for complications such as twin-twin transfusion syndrome, selective fetal growth restriction, and preterm labor. Ultrasound is a non-invasive and highly useful tool for screening, diagnosis, and guiding management of these potential complications. Ultrasound monitoring protocols vary between different types of twin pregnancies.
Image by Kevin Dufendach, MD (2008). Used by permission. CC BY 3.0
Lambda or Delta Sign Indicating Dichorionic Twins
T Sign Indicating Monochorionic Twins
Uncomplicated monochorionic twin pregnancy
Uncomplicated dichorionic twin pregnancy
Note: ISUOG guidelines do include umbilical artery Doppler monitoring as part of routine surveillance | ACOG/ SMFM does not consider evidence to be sufficient for umbilical artery Doppler or antepartum testing in the case of uncomplicated dichorionic twins
Most twin pregnancies will have good outcomes. However, diligence is required, especially in the case of monochorionic twins due to risk for twin-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). Monochorionic twins may have potentially significant vascular anastomoses such that the twins share a common vasculature. Significant risks for dichorionic twins include preterm labor, medical complications due to increased placental mass (e.g., preeclampsia and GDM) and selective growth restriction. Different centers will have different protocols for labeling twin A vs twin B. The important point to remember is to be consistent with labeling.
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OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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