Re: R: Two Yolk Sacs, one embryo
From: art fougner, md (evsono@pipeline.com)
Wed Jan 22 17:26:35 2003
amen - in this setting - when in doubt, wait it out.
art
At Wed, 22 Jan 2003, Andrea Corda wrote:
>
>Dr.Libardi,
>With y.s. diameters as measured,then I'm absolutely wrong -ehr rate confirming you're dealing with a normal pregnancy-and the second embryo will show up in due time with just a little difference in CRL and ehr of course.
>Then it all should depend on the timing of the blastocyst division and the amount of cells gone into each half.
>Normal monochorionic diamniotic pregnancy
>Let's see the follow up
>Thanks
>A.Corda MD
>
>>> ----- Original Message -----
> From: Mário Libardi
> To: Multiple recipients of list ULTRASOUND
> Sent: Wednesday, January 22, 2003 6:13 PM
> Subject: Re: Two Yolk Sacs, one embryo
>
> Doctor Berck
>
> You are correct.I am wrong.The number of YS represents the number of amnions.It's impossible conjoined twins in this case.
>
> See this excerpt:
>
> "Especially in nonchorionic diamniotic or monoamniotic twins only after the 8th week of gestation, one can safely determine the amnionicity. Also, the number of yolk sacs imaged is correlated with the number of amnions, and the number of yolk sacs can be observed at least two weeks before the number of amnions."
>
> The First World Congress On: Controversies in Obstetrics, Gynecology & Infertility Prague, Czech Republic - 1999
>
> Can Ultrasound Determine Chorionicity and Amnionicity in Mutiple Pregnancy?
> I. Meizner
> Ultrasound Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
>
> Regards
> Mário Libardi
>
>>> ----- Original Message -----
> From: Dave Berck
> To: Multiple recipients of list ULTRASOUND
> Sent: Wednesday, January 22, 2003 1:19 PM
> Subject: Re: Two Yolk Sacs, one embryo
>
> How could this be conjoined twins?
> Conjoined twins are by definition monochorionic
> monoamniotic and have 1 yolk sac. If there are two
> yolk sacs, it is mono / di. Am I wrong?
>
> --- "Terry J. DuBose" <duboseterryj@uams.edu> wrote:
> > With "
> > >LMP : 6 weeks and CRL 5 weks and 5 days.
> > " and an EHR of 119 B/M which calculates to 5.9
> > weeks or 5w6.7 days, the heart rate is absolutely
> > normal for the age. The follow-up on Jan 31 will be
> > 7.3 weeks, and I will predict that the hear rate
> > will be near 151 at that time... and you will likely
> > find a second CRL and heart rate that will be
> > corresponding smaller and slower.
> >
> > Can't wait to here what happens. Terry
> >
> > ultrasound@obgyn.net writes:
> > > Terry and friends
> > >
> > >I'm worry about conjoined twins possibility in this
> > case.During scan I can't separate the two yolk
> > sacs.I agree that in some days the other embrio will
> > appear.Very interesting your article about EHR and
> > IG.In this case the EHR of the embrio is 119 bpm.
> > >Dr.Corda, the YS diameters is 3.7mm(embrio) and
> > 3.5mm(non-embrio).
> > >The patient will return in January 31.I'll post the
> > follow up.
> > >
> > >Regards
> > >
> > >Mário
> > >
>
>>> > >----- Original Message -----
> > >From: [ mailto:duboseterryj@uams.edu ]Terry J.
> > > DuBose
> > >To: [ mailto:ultrasound@mail.medispecialty.com
> > ]Multiple recipients of list
> > > ULTRASOUND
> > >Sent: Tuesday, January 21, 2003 9:23 PM
> > >Subject: Re: Two Yolk Sacs, one embryo
> > >
> > >My first thought is that if you wait 3-4 days, the
> > other twin will show up... I have seen cases where
> > one twin was larger than the other by up to 6
> > days... and their heart rates correlated with their
> > CRL sizes both in the acceleration and deceleration
> > phases. Our hypothesis was that when the cell mass
> > split, one twin got a larger mass of cells. Both
> > were normal, but remained about a week different in
> > size until delivery. Check out this article:
> > >
> > >[
> >
>
> http://www.obgyn.net/english/pubs/features/dubose/ehr-age.htm
> >
>
> ]http://www.obgyn.net/english/pubs/features/dubose/ehr-age.htm
> > >particularly this image:
> > >[
> >
>
> http://www.obgyn.net/english/pubs/features/dubose/Image16.gif
> >
>
> ]http://www.obgyn.net/english/pubs/features/dubose/Image16.gif
> > >
> > >I also described this set of twins in detail in
> > FETAL SONOGRAPHY, p. 151-154.
> > >
> > >Or you may need to watch for conjoined twins later.
> > >
> > >Either way, please follow this one, give us feed
> > back... and get accurate measurement on the CRL and
> > EHR over the next month. Interesting case.
> > >
> > >Good luck. Terry J DuBose.
> > >
> > >[ mailto:ultrasound@obgyn.net ]ultrasound@obgyn.net
> > writes:
> > >> Patient with 25 years old, G2P1A0, LMP : 6 weeks
> > and CRL 5 weks and 5 days .
> > >>
> > >>US findings:
> > >>Two yolk sacs side by side, but only one embryo
> > identified.
> > >>
> > >>Opinions ?? Suggestions ???
> > >>
> > >>Regards
> > >>Mário Libardi, M.D.
> > >>Multimagem Ultra-sonografia
> > >>Botucatu - Sao Paulo
> > >>Brazil
> > >
> > >Peace, Terry J. DuBose, M.S., RDMS
> > >Assistant Professor & Director, Diagnostic Medical
> > Sonography Program
> > >University of Arkansas for Medical Sciences, CHRP
> > >4301 West Markham St. Mail Slot #563
> > >Little Rock, Arkansas, 72205 USA
> > >501-686-6510
> > >[ mailto:DuBoseTerryJ@UAMS.edu
> > ]DuBoseTerryJ@UAMS.edu
> > >[ http://www.io.com/~dubose/
> > ]http://www.io.com/~dubose/
> > >[ http://www.uams.edu/CHRP/dmshome.htm
> > ]http://www.uams.edu/CHRP/dmshome.htm
> > >[ http://www.obgyn.net/us/panel/panel.htm
> > ]http://www.obgyn.net/us/panel/panel.htm
> > >
> >
> > Peace, Terry J. DuBose, M.S., RDMS
> > Assistant Professor & Director, Diagnostic Medical
> > Sonography Program
> > University of Arkansas for Medical Sciences, CHRP
> > 4301 West Markham St. Mail Slot #563
> > Little Rock, Arkansas, 72205 USA
> > 501-686-6510
> > DuBoseTerryJ@UAMS.edu
> > http://www.io.com/~dubose/
> > http://www.uams.edu/CHRP/dmshome.htm
> > http://www.obgyn.net/us/panel/panel.htm
> >
>
> =====
> David J. Berck, MD, MPH
--
art fougner, md
ich bin ein New Yorker
