Dichorionic Twin Pregnancy, with One Twin Having Reversed Diastolic Flow in the Umbilical Artery

Section 1—Quiz

A 25-year-old woman at 19^th week of twin pregnancy, claiming no noticeable medical history or obstetrical history, was referred by a local medical doctor due to a significant fetal weight difference between the twins.

According to the patient, the local medical practitioner reported that this could be a case of dichorionic twins, based on antepartum examination and the image shown in Figure 1. And the ultrasound which was performed in the clinic revealed that the smaller twin had severe oligohy-dramnios and reversed end-diastolic flow in the umbilical artery. By contrast, the larger one was diagnosed with polyhydramnios (Figures 2 and 3). What could be the differential diagnosis?

Figure 1.

Local medical doctor diagnosed the twins as dichorionic, on the basis of this picture.

Figure 2.

One of the twins was diagnosed with oligohydramnios and the other with polyhydramnios.

Figure 3.

Umbilical artery flow of the smaller twin is reverse of the end-diastolic flow.