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Monochorionic Diamniotic Twins
Priyanka Jha, MBBS; Anne Kennedy, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Monochorionic diamniotic twins (MDT, MoDi twins)
          • Synonyms

            • Identical twins
          • Definitions

            • Zygosity refers to type of conception
              • Dizygotic (DZ) or nonidentical twins are result of multiple ovulations with 2 sperm fertilizing 2 ova
              • Monozygotic (MZ) or identical twins result from division of single zygote (1 sperm fertilizes 1 ovum)
            • Chorionicity refers to type of placentation
              • MZ pregnancies may be monochorionic (MC) or dichorionic (DC) depending on when zygote divides
              • DZ twins always have DC placentation (although can have "fused" placenta)

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Microscopic Features

                      CLINICAL ISSUES

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Aviram A et al: Delivery of monochorionic twins - lessons learned from the Twin Birth Study. Am J Obstet Gynecol. 223(6):916.e1-9, 2020
                                  2. Badr DA et al: Evaluation of the new expert consensus-based definition of selective fetal growth restriction in monochorionic pregnancies. J Matern Fetal Neonatal Med. 1-7, 2020
                                  3. Marleen S et al: Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29,864 twin pregnancies. BJOG. ePub, 2020
                                  4. Mogra R et al: Prospective validation of first-trimester ultrasound characteristics as predictive tools for twin-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies. Fetal Diagn Ther. 47(4):321-7, 2020
                                  5. Pandya VM et al: Comparison of crown-rump length discordance and abnormal cord insertions as first-trimester predictors of poor outcome in monochorionic diamniotic twin pregnancies. J Matern Fetal Neonatal Med. 1-5, 2020
                                  6. Shanahan MA et al: Placental anatomy and function in twin gestations. Obstet Gynecol Clin North Am. 47(1):99-116, 2020
                                  7. Shi X et al: Prenatal and perinatal outcomes of twin pregnancy discordant for one fetus with nuchal translucency above the 95th percentile. J Matern Fetal Neonatal Med. 1-6, 2020
                                  8. SMFM Patient Safety and Quality Committee, Society for Maternal-Fetal Medicine. et al: SMFM special statement: updated checklists for management of monochorionic twin pregnancy. Am J Obstet Gynecol. 223(5):B16-20, 2020
                                  9. Takahashi K et al: Monochorionic diamniotic twins of discordant external genitalia with 45,X/46,XY mosaicism. Mol Genet Genomic Med. e1382, 2020
                                  10. Jha P et al: US evaluation of twin pregnancies: importance of chorionicity and amnionicity. Radiographics. 39(7):2146-66, 2019
                                  11. Fishel-Bartal M et al: Can middle cerebral artery peak systolic velocity predict polycythemia in monochorionic diamniotic twins? Evidence from a prospective cohort study. Ultrasound Obstet Gynecol. 48(4):470-5, 2016
                                  12. ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 47(2):247-63, 2016
                                  13. Stagnati V et al: Inter-twin discrepancy in middle cerebral artery peak systolic velocity and pregnancy outcome in monochorionic diamniotic twin pregnancies. Ultrasound Obstet Gynecol. 48(1):66-71, 2016
                                  14. Bahtiyar MO et al: The North American Fetal Therapy Network consensus statement: prenatal surveillance of uncomplicated monochorionic gestations. Obstet Gynecol. 125(1):118-23, 2015
                                  15. Emery SP et al: The North American Fetal Therapy Network consensus statement: management of complicated monochorionic gestations. Obstet Gynecol. 126(3):575-84, 2015
                                  16. Emery SP et al: The North American Fetal Therapy Network consensus statement: prenatal management of uncomplicated monochorionic gestations. Obstet Gynecol. 125(5):1236-43, 2015
                                  17. Fichera A et al: Outcome of monochorionic diamniotic twin pregnancies followed at a single center. Prenat Diagn. 35(11):1057-64, 2015
                                  18. Allaf MB et al: Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? J Ultrasound Med. 33(9):1573-8, 2014
                                  19. American College of Obstetricians and Gynecologists et al: ACOG practice bulletin no. 144: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 123(5):1118-32, 2014
                                  20. Lewi L et al: Growth discordance. Best Pract Res Clin Obstet Gynaecol. 28(2):295-303, 2014
                                  21. Danon D et al: Increased stillbirth in uncomplicated monochorionic twin pregnancies: a systematic review and meta-analysis. Obstet Gynecol. 121(6):1318-26, 2013
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Monochorionic diamniotic twins (MDT, MoDi twins)
                                          • Synonyms

                                            • Identical twins
                                          • Definitions

                                            • Zygosity refers to type of conception
                                              • Dizygotic (DZ) or nonidentical twins are result of multiple ovulations with 2 sperm fertilizing 2 ova
                                              • Monozygotic (MZ) or identical twins result from division of single zygote (1 sperm fertilizes 1 ovum)
                                            • Chorionicity refers to type of placentation
                                              • MZ pregnancies may be monochorionic (MC) or dichorionic (DC) depending on when zygote divides
                                              • DZ twins always have DC placentation (although can have "fused" placenta)

                                          IMAGING

                                          • General Features

                                            • Ultrasonographic Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Microscopic Features

                                                      CLINICAL ISSUES

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Aviram A et al: Delivery of monochorionic twins - lessons learned from the Twin Birth Study. Am J Obstet Gynecol. 223(6):916.e1-9, 2020
                                                                  2. Badr DA et al: Evaluation of the new expert consensus-based definition of selective fetal growth restriction in monochorionic pregnancies. J Matern Fetal Neonatal Med. 1-7, 2020
                                                                  3. Marleen S et al: Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29,864 twin pregnancies. BJOG. ePub, 2020
                                                                  4. Mogra R et al: Prospective validation of first-trimester ultrasound characteristics as predictive tools for twin-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies. Fetal Diagn Ther. 47(4):321-7, 2020
                                                                  5. Pandya VM et al: Comparison of crown-rump length discordance and abnormal cord insertions as first-trimester predictors of poor outcome in monochorionic diamniotic twin pregnancies. J Matern Fetal Neonatal Med. 1-5, 2020
                                                                  6. Shanahan MA et al: Placental anatomy and function in twin gestations. Obstet Gynecol Clin North Am. 47(1):99-116, 2020
                                                                  7. Shi X et al: Prenatal and perinatal outcomes of twin pregnancy discordant for one fetus with nuchal translucency above the 95th percentile. J Matern Fetal Neonatal Med. 1-6, 2020
                                                                  8. SMFM Patient Safety and Quality Committee, Society for Maternal-Fetal Medicine. et al: SMFM special statement: updated checklists for management of monochorionic twin pregnancy. Am J Obstet Gynecol. 223(5):B16-20, 2020
                                                                  9. Takahashi K et al: Monochorionic diamniotic twins of discordant external genitalia with 45,X/46,XY mosaicism. Mol Genet Genomic Med. e1382, 2020
                                                                  10. Jha P et al: US evaluation of twin pregnancies: importance of chorionicity and amnionicity. Radiographics. 39(7):2146-66, 2019
                                                                  11. Fishel-Bartal M et al: Can middle cerebral artery peak systolic velocity predict polycythemia in monochorionic diamniotic twins? Evidence from a prospective cohort study. Ultrasound Obstet Gynecol. 48(4):470-5, 2016
                                                                  12. ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 47(2):247-63, 2016
                                                                  13. Stagnati V et al: Inter-twin discrepancy in middle cerebral artery peak systolic velocity and pregnancy outcome in monochorionic diamniotic twin pregnancies. Ultrasound Obstet Gynecol. 48(1):66-71, 2016
                                                                  14. Bahtiyar MO et al: The North American Fetal Therapy Network consensus statement: prenatal surveillance of uncomplicated monochorionic gestations. Obstet Gynecol. 125(1):118-23, 2015
                                                                  15. Emery SP et al: The North American Fetal Therapy Network consensus statement: management of complicated monochorionic gestations. Obstet Gynecol. 126(3):575-84, 2015
                                                                  16. Emery SP et al: The North American Fetal Therapy Network consensus statement: prenatal management of uncomplicated monochorionic gestations. Obstet Gynecol. 125(5):1236-43, 2015
                                                                  17. Fichera A et al: Outcome of monochorionic diamniotic twin pregnancies followed at a single center. Prenat Diagn. 35(11):1057-64, 2015
                                                                  18. Allaf MB et al: Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? J Ultrasound Med. 33(9):1573-8, 2014
                                                                  19. American College of Obstetricians and Gynecologists et al: ACOG practice bulletin no. 144: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 123(5):1118-32, 2014
                                                                  20. Lewi L et al: Growth discordance. Best Pract Res Clin Obstet Gynaecol. 28(2):295-303, 2014
                                                                  21. Danon D et al: Increased stillbirth in uncomplicated monochorionic twin pregnancies: a systematic review and meta-analysis. Obstet Gynecol. 121(6):1318-26, 2013