D I S S E C T I N G B U S I N E S S
in an unequal flow of blood – affecting 10 to 15 % of monochorionic ( MC ) twins , with the risk being greater for MCDA twins . Research suggests that MC twins are also at greater risk of additional complications affecting the placenta , including Twin Anaemia Polycythaemia Sequence ( TAPS ) and Selective Foetal Growth Restriction ( sFGR ). Left undiagnosed and untreated , these conditions can lead to devastating consequences , making close monitoring throughout gestation via regular , high-quality ultrasound , vital .
pregnancy due to a lack of visibility of the inner membrane . This is where having the most up-to-date equipment , providing fine detail and high-resolution images , is extremely important .
Delving deeper
Should a growth restriction or other abnormality be identified – such as TTTS – then the use of colour Doppler imaging ( CDI ) technology can enable the sonographer to take a closer look and interrogate the tiny vessels in the umbilical cord and placenta .
Superb Micro-vascular Imaging ( SMI ) technology is an award-winning Doppler technology proving to be extremely effective in this area . Unlike traditional colour Doppler imaging , which removes clutter from images by suppressing low-velocity components , SMI expands the range of visible blood flow from low to high velocities with incredible sensitivity .
Jane Hanford , Clinical Business Development Manager for Women ’ s Health Ultrasound at Canon Medical Systems UK
The importance of high-end modern equipment
SMI separates blood flow from overlaying tissue motion effectively , while preserving even the subtlest low-flow components with superior detail and definition – meaning that clarity needn ’ t be sacrificed . SMI is found to be superior in terms of high frame rate , high sensitivity , high resolution , and less motion artefact – making blood flow easier to analyse , especially when visualising the microvasculature flow of the placenta .
Predicting risk
While entry-level2D ultrasound equipment is sufficient in determining multiple pregnancies , and the type of placentation , a high-end ultrasound machine providing optimal clarity is recommended to efficiently identify symptoms associated with any anomalies .
In addition to regular monitoring 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 are any Polyhydramnios or Oligohydramnios . In a recent webinar on the topic , Dr Monique Haak 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
Professor Christoph Lees is currently conducting research , funded by the Medical Research Council and the Wiseman Trust , to understand whether existing ultrasound technology , including SMI , can be used to look at the blood vessels within the placenta of MCDA twins . The study aims to understand how and where they join in predicting the risk of developing TTTS , along with other serious complications .
This ongoing research consists of a study carried out in London in May 2019 , which used a Canon Aplio i-series ultrasound machine to map placental angioarchitecture ( the arrangement and distribution of blood vessels ) in MC pregnancies using different colour Doppler filters . According to Professor Lees , placental angioarchitecture is important
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