title: Ultrasonographic evaluation of myometrial thickness in twin pregnancies.
abstract: OBJECTIVE
  The objective of the study was to evaluate longitudinally the in vivo changes in myometrial thickness (MT) during gestation in patients carrying twin gestations in relation to pregnancy outcome.
  
  
  METHODS
  Serial abdominal ultrasounds were performed prospectively in 92 patients carrying twin gestations through each trimester. Ninety-seven patients pregnant with singletons served as controls. For twins, the primary endpoint was spontaneous delivery at less than 35 weeks' gestational age (GA). The myometrium was defined sonographically as the echohomogeneous layer between the serosa and the decidua and was measured at the anterior, fundal, and lower uterine segment (LUS) walls. The estimated fetal weight, maximum vertical pocket of amniotic fluid, and placental thickness were also assessed ultrasonographically at the same time as the MT and served as estimates for the contribution of each to the uterine volume. In twins, cervical length measurements were performed transvaginally, as clinically indicated. Data analysis included 2-way analysis of variance and linear, nonlinear, and multivariate regression.
  
  
  RESULTS
  A total of 41.3% of twin pregnancies (38 of 92) delivered preterm (< 35 weeks). There were no significant changes in measurements at the anterior and fundal site over time throughout pregnancy and no differences in these sites between twin and singleton gestations. Conversely, in both twins and singletons, there was a significant and gradual thinning of the LUS myometrium during gestation. In the absence of uterine contractions or symptoms of preterm labor, twins that delivered preterm had a significantly thinner LUS at an earlier gestation, compared with twins that delivered at term (P < .001), suggesting that LUS thinning occurred earlier in these cases. There was a significant correlation between cervical length and LUS thinning during gestation in twins that delivered 35 weeks GA or later (r = 0.352; P < .001) but not in those that delivered preterm (< 35 weeks GA; r = 0.125; P = .326).
  
  
  CONCLUSIONS
  Twin pregnancy is characterized by a significant, selective, and gradual thinning of the LUS during gestation, which does not occur in the anterior and fundal myometrium. Thinning of the LUS occurs earlier in twin pregnancies destined to deliver preterm. These observations suggest that similar to the cervix, the LUS changes dynamically during twin pregnancy and that this too may be assessed through ultrasound imaging.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA. anna.sfakianaki@yale.edu
authors.forename: Anna K
authors.initials: AK
authors.lastname: Sfakianaki
authors.forename: Irina A
authors.initials: IA
authors.lastname: Buhimschi
authors.forename: Christian M
authors.initials: CM
authors.lastname: Pettker
authors.forename: Lissa K
authors.initials: LK
authors.lastname: Magloire
authors.forename: Ozhan M
authors.initials: OM
authors.lastname: Turan
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Hamar
authors.forename: Catalin S
authors.initials: CS
authors.lastname: Buhimschi
mesh_terms: D034861:Abdominal Wall / Q000000981:diagnostic imaging; D000222:Adaptation, Physiological; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D015999:Multivariate Analysis; D009215:Myometrium / Q000000981:diagnostic imaging* / Q000502:physiology / Q000503:physiopathology*; D007752:Obstetric Labor, Premature / Q000503:physiopathology; D010920:Placenta / Q000502:physiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third / Q000502:physiology; D011272:Pregnancy, Multiple / Q000502:physiology*; D011312:Pressure; D016216:Ultrasonography, Prenatal