Imaging
Importance of imaging quality in women’s health
Around 1.6 million twins are born each year worldwide, as multiple pregnancies continue to increase. However, these pregnancies carry greater risks of perinatal mortality and morbidity. Jane Hanford, explores how the evolution of high-quality ultrasound and imaging innovation, particularly Superb Micro-vascular Imaging (SMI) technology, is helping sonographers to identify potential risks early on, and allow for more effective treatment options.
Women’s health ultrasound - where do we start? From routine screening to high-risk assessment in obstetrics, gynaecology and breast imaging, it is critical to start with, and maintain, high image quality across ultrasound for the benefit of women’s health. Every examination is important. If we look at multiple pregnancies, and the associated risks, it is clear that superior image quality and the use of advanced applications are making a real impact in aiding diagnosis and providing clinical confidence. Multiple pregnancies are increasing. As of
2021, reports suggest that 1.6 million twins are born worldwide each year,1
and due to
increasing maternal age and the rise in assisted reproduction, this trend is showing no signs of slowing down. These pregnancies carry greater risks than singleton pregnancies and are often associated with increased danger of perinatal mortality and morbidity.2
Not only are the risks
of experiencing conditions such as premature labour, pre-eclampsia, placenta abruption, and fetal growth restrictions heightened, but further complications can also arise, depending on the type of multiples.3 For medical purposes, there are three types
of twins: dichorionic diamniotic (DCDA), where each has their own separate placenta and separate sac; monochorionic diamniotic (MCDA), where they share a single placenta but have their own separate sacs; and monochorionic monoamniotic (MCMA) twins, where they share both a placenta and a sac – this is a much rarer type of pregnancy.4 Assessment of the placenta in twins is
therefore crucial, and one of the most serious conditions is Twin-to-Twin Transfusion Syndrome (TTTS) – an abnormality of the placenta resulting in an unequal flow of blood – affecting 10% to 15% of monochorionic (MC) twins,5
with the risk being greater for MCDA twins. Ongoing research
suggests that MC twins are also at greater risk of additional complications affecting the placenta, including Twin Anaemia Polycythaemia Sequence (TAPS) and Selective Fetal Growth Restriction (sFGR).6
Left undiagnosed and untreated, complications, such as these, can lead to devastating consequences, making close monitoring throughout gestation (as often as every two weeks)7
ultrasound, vital to ensuring a healthy and successful pregnancy.
Why high-end modern equipment is a must While entry-level 2D ultrasound equipment is sufficient in determining multiple pregnancies, and the type of placentation (chorionicity and amnionicity),8
a high-end ultrasound machine
providing optimal clarity and high-resolution detail is recommended to efficiently identify symptoms associated with any complications or
abnormalities. These cases can then be referred to a Fetal Medical Consultant for further investigation and diagnosis if required. In addition to monitoring growth regularly
via regular, high-quality
to identify any growth discrepancy in TTTS, sonographers typically look at the amount of fluid each baby has in the amniotic sac by measuring the depth of the deepest vertical pocket. This is to identify if there is any Polyhydramnios (excessive amniotic fluid) due to volume overload, or Oligohydramnios, (reduced levels of amniotic fluid). In a recent webinar on the topic,9
Dr. Monique Haak
cited the membrane, bladder, and placenta thickness, in addition to amniotic fluid, as the cornerstones for diagnosis. She also revealed a common pitfall when diagnosing TTTS in MCDA twins, warning that the condition can be easily interpreted as growth restrictions in an MCMA twin pregnancy, due to a lack of visibility of the inner membrane. This is where having the most up-to-date
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