Chorioamniotic membrane separation over the cervical os ("moon sign") in twin-twin transfusion syndrome

Shivani Patel, Lisa M. Korst, Arlyn Llanes, Richard H. Lee, Joseph G. Ouzounian, Ramen H. Chmait

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives-To determine whether chorioamniotic membrane separation from the internal cervical os, the "moon sign," is associated with preterm premature rupture of membranes (PPROM) in twin-twin transfusion syndrome (TTTS). Methods-A retrospective study of patients with TTTS treated with laser surgery was performed. Membrane separation before and after surgery was tested against any PPROM, PPROM within 7 days, and PPROM within 21 days. Because intrauterine fetal demise (IUFD) was weakly associated with PPROM, these cases were studied separately. Results-Among 304 consecutive patients, 247 patients (81.3%) had no IUFD, and preoperative and postoperative membrane separation rates were 13.4% and 13.0%, respectively. In 7 cases (2.8%), preoperative membrane separation disappeared postoperatively, and in 6 cases (2.4%), membrane separation appeared postoperatively; 26 cases (10.5%) had membrane separation at both times. Rates of PPROM did not differ between those who did and did not have preoperative membrane separation (30.3% versus 28.0%; P= .9511). Among those with and without postoperative membrane separation, the rates of any PPROM were 34.4% and 27.4%, respectively (P = .5473), and the rates of PPROM within 21 days were 15.6% and 5.6% (P = .0524). Those with postoperative membrane separation were 3 times more likely to have PPROM within 21 days (odds ratio, 3.13; 95% confidence interval, 1.02-9.58; P= .0453). Preterm premature rupture of membranes was not associated with preoperative or postoperative membrane separation in patients with IUFD. Conclusions-The preoperative moon sign does not appear to be associated with PPROM in TTTS. Postoperatively, membrane separation may be weakly associated with PPROM at 21 days, but further research is required to confirm this association.

Original languageEnglish (US)
Pages (from-to)1147-1154
Number of pages8
JournalJournal of Ultrasound in Medicine
Volume33
Issue number7
DOIs
StatePublished - Jul 1 2014

Fingerprint

Fetofetal Transfusion
Membranes
Fetal Death
Preterm Premature Rupture of the Membranes
Laser Therapy

Keywords

  • Chorioamniotic membrane separation
  • Endovaginal sonography
  • Moon sign
  • Obstetric ultrasound
  • Rupture of membranes
  • Twin-twin transfusion syndrome

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Medicine(all)

Cite this

Chorioamniotic membrane separation over the cervical os ("moon sign") in twin-twin transfusion syndrome. / Patel, Shivani; Korst, Lisa M.; Llanes, Arlyn; Lee, Richard H.; Ouzounian, Joseph G.; Chmait, Ramen H.

In: Journal of Ultrasound in Medicine, Vol. 33, No. 7, 01.07.2014, p. 1147-1154.

Research output: Contribution to journalArticle

Patel, Shivani ; Korst, Lisa M. ; Llanes, Arlyn ; Lee, Richard H. ; Ouzounian, Joseph G. ; Chmait, Ramen H. / Chorioamniotic membrane separation over the cervical os ("moon sign") in twin-twin transfusion syndrome. In: Journal of Ultrasound in Medicine. 2014 ; Vol. 33, No. 7. pp. 1147-1154.
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AU - Patel, Shivani

AU - Korst, Lisa M.

AU - Llanes, Arlyn

AU - Lee, Richard H.

AU - Ouzounian, Joseph G.

AU - Chmait, Ramen H.

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N2 - Objectives-To determine whether chorioamniotic membrane separation from the internal cervical os, the "moon sign," is associated with preterm premature rupture of membranes (PPROM) in twin-twin transfusion syndrome (TTTS). Methods-A retrospective study of patients with TTTS treated with laser surgery was performed. Membrane separation before and after surgery was tested against any PPROM, PPROM within 7 days, and PPROM within 21 days. Because intrauterine fetal demise (IUFD) was weakly associated with PPROM, these cases were studied separately. Results-Among 304 consecutive patients, 247 patients (81.3%) had no IUFD, and preoperative and postoperative membrane separation rates were 13.4% and 13.0%, respectively. In 7 cases (2.8%), preoperative membrane separation disappeared postoperatively, and in 6 cases (2.4%), membrane separation appeared postoperatively; 26 cases (10.5%) had membrane separation at both times. Rates of PPROM did not differ between those who did and did not have preoperative membrane separation (30.3% versus 28.0%; P= .9511). Among those with and without postoperative membrane separation, the rates of any PPROM were 34.4% and 27.4%, respectively (P = .5473), and the rates of PPROM within 21 days were 15.6% and 5.6% (P = .0524). Those with postoperative membrane separation were 3 times more likely to have PPROM within 21 days (odds ratio, 3.13; 95% confidence interval, 1.02-9.58; P= .0453). Preterm premature rupture of membranes was not associated with preoperative or postoperative membrane separation in patients with IUFD. Conclusions-The preoperative moon sign does not appear to be associated with PPROM in TTTS. Postoperatively, membrane separation may be weakly associated with PPROM at 21 days, but further research is required to confirm this association.

AB - Objectives-To determine whether chorioamniotic membrane separation from the internal cervical os, the "moon sign," is associated with preterm premature rupture of membranes (PPROM) in twin-twin transfusion syndrome (TTTS). Methods-A retrospective study of patients with TTTS treated with laser surgery was performed. Membrane separation before and after surgery was tested against any PPROM, PPROM within 7 days, and PPROM within 21 days. Because intrauterine fetal demise (IUFD) was weakly associated with PPROM, these cases were studied separately. Results-Among 304 consecutive patients, 247 patients (81.3%) had no IUFD, and preoperative and postoperative membrane separation rates were 13.4% and 13.0%, respectively. In 7 cases (2.8%), preoperative membrane separation disappeared postoperatively, and in 6 cases (2.4%), membrane separation appeared postoperatively; 26 cases (10.5%) had membrane separation at both times. Rates of PPROM did not differ between those who did and did not have preoperative membrane separation (30.3% versus 28.0%; P= .9511). Among those with and without postoperative membrane separation, the rates of any PPROM were 34.4% and 27.4%, respectively (P = .5473), and the rates of PPROM within 21 days were 15.6% and 5.6% (P = .0524). Those with postoperative membrane separation were 3 times more likely to have PPROM within 21 days (odds ratio, 3.13; 95% confidence interval, 1.02-9.58; P= .0453). Preterm premature rupture of membranes was not associated with preoperative or postoperative membrane separation in patients with IUFD. Conclusions-The preoperative moon sign does not appear to be associated with PPROM in TTTS. Postoperatively, membrane separation may be weakly associated with PPROM at 21 days, but further research is required to confirm this association.

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KW - Endovaginal sonography

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KW - Obstetric ultrasound

KW - Rupture of membranes

KW - Twin-twin transfusion syndrome

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