Re: Yolk sac number in multiple gestations (monochorionic)
From: art fougner, md (evsono@pipeline.com)
Fri Jun 25 11:31:58 2004
Terry
i suggest awaiting the follow-up in one week.
art
At Fri, 25 Jun 2004, DuBose, Terry wrote:
>
>Dr. Moroder's video clip:
>http://fetalmedicine.tripod.com/test.avi (allow the 1,1 MB avi clip to
>be downloaded).
>Makes me wonder if Rich Dempsey's case might be twins, with a "double
>bleb" as the video shows, and a discordantly small twin that hasn't
>developed the amnion large enough to be visualized yet?
>
>Dempsey's case is being formatted for the EAB to review. Thanks, Terry
>
>Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>
>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/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>---------------------------------------------------------------
>---------------------------------------------------------------
>-----Original Message-----
>---------------------------------------------------------------
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>---------------------------------------------------------------
>Wolfgang Moroder, M.D.
>---------------------------------------------------------------
>Sent: Thursday, June 24, 2004 3:12 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Yolk sac number in multiple gestations (monochorionic)
>
>Dear Colleagues:
>
>I have been puzzled a lot by early sonoembryologic features. In the
>case presented by Rich Dempsey I should like to post the following
>comments:
>1) I doubt that a cystic structure of 9 mm with absent heart pulsation,
>in a gestational sac of 5 weeks is compatible with an intact early
>pregnancy,
>2) as shown in the following case that I published on OBGYN.net
>http://www.obgyn.net/us/gallery/OB_1_Normal_Monoamniotic_Twins.jpg
>
>http://www.obgyn.net/us/gallery/OB_1_Normal_Monoamniotic_Twins_Yolk_Sacs
>.jpg
>I have seen two early monoamniotic pregnancies with a yolk sac for each
>twin embryo, therefore even monoamniotic multiple pregnancies are
>associated with multiple yolk sacs,
>3) early embryonic failure is often characterized by a disproportioned
>growth of the amniotic sac compared to the embryonic size, even if the
>embryo is still alive as you can observe in this videoclip:
>
>http://fetalmedicine.tripod.com/test.avi (allow the 1,1 MB avi clip to
>be downloaded).
>In this case you can observe a double cystic structure of different
>size, the major cyst being 8 mm. in diameter. A pulsating embryonic
>pole can be observed between them. It is difficult to distinguish in
>this case an overgrown amniotic sac from an oversized yolk sac. This
>was an early pregnancy failure. Please let us know the F/U and, why
>not, send us a picture.
>I'd welcome lots of comments.
>Wolfgang Moroder
>
>At Wed, 23 Jun 2004, Rich Dempsey RDMS/RVT wrote:
>>
>>While EV scanning with a student, an early IUP (5.1 wks by GSD) was
>>seen- a single gestational sac containing 3 cystic structures; the
>>largest of which was 9mm. The question arose: ? In a single
>gestational
>>sac (presumably a monochorionic gestation) is it possible to have 3
>yolk
>>sacs, or can this be a combination of a yolk sac, vitelline membrane
>>plus possibly an early amniotic membrane. ? No embyronic pole was seen
>>(yet), no bHCG was available, however LMP and GSD placed this probable
>>early IUP at 5 weeks.
>>
>>Please forgive my hazy ignorance of embryology (and spelling).
>
>--
>Wolfgang Moroder, MD
>Prenatal Unit
>Bolzano General Hospital Italy
>
--
art fougner, md
ich bin ein New Yorker
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