Document Detail

The amniotic wrinkle: a pitfall in evaluating amniotic fluid for twins.
MedLine Citation:
PMID:  20103796     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The sonographic analysis of amniotic fluid in twin pregnancies can be complex and difficult, particularly when one twin has oligohydramnios or anhydramnios. This article describes a pitfall, the "amniotic wrinkle," which can lead to the erroneous impression that both twins have adequate fluid when one actually has little or none. METHODS: Sonograms of twin pregnancies in which the sonographer's initial assessment was of adequate fluid for each twin but imaging by the author on the same day showed one twin to have oligohydramnios were analyzed to identify recurring image patterns related to the intertwin membrane that may create this misleading impression. RESULTS: With oligohydramnios of one twin, the intertwin membrane may become redundant, folding on itself, creating an amniotic wrinkle: a short linear structure extending perpendicularly away from the twin with decreased amniotic fluid in toward the amniotic space of the other twin. A variation of this occurs when this fetus moves an extremity into the fold, with the two layers of the fold apposing each other between the limb and torso or between two limbs. An additional pattern is also described: an intrauterine sling or "cocoon" in which a fetus appears to be suspended within the amniotic space of the other twin. CONCLUSIONS: To avoid pitfalls in assessing amniotic fluid for twins, the intertwin membrane should be shown in every image that is used to document fluid ascribed to each twin, and images at right angles to the initial image can help identify an amniotic wrinkle.
Harris J Finberg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine     Volume:  29     ISSN:  1550-9613     ISO Abbreviation:  J Ultrasound Med     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-05-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211547     Medline TA:  J Ultrasound Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  249-54     Citation Subset:  IM    
Department of Diagnostic Ultrasound, Phoenix Perinatal Associates, Obstetrix Medical Group, 3877 N Seventh St, 400, Phoenix, AZ 85012 USA.
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MeSH Terms
Amniotic Fluid / ultrasonography*
Diagnosis, Differential
Fetofetal Transfusion / ultrasonography*
Oligohydramnios / ultrasonography*
Ultrasonography, Prenatal / methods*

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