Radiologic Approaches In The Detection And Monitoring of Multiple Pregnancy Complications

Multiple pregnancy, defined as the gestation of two or more fetuses, is a high-risk condition asso- ciated with increased maternal and fetal morbidity and mortality. The global incidence varies geo- graphically, with Africa particularly Nigeria recording the highest rates. Twin pregnancies consti- tute over 98% of multiple gestations, and their risk profile intensifies with the number of fetuses. Complications such as preterm birth, fetal growth restriction, twin-to-twin transfusion syndrome (TTTS), and maternal hypertensive disorders are common. Radiology plays a pivotal role in the diagnosis, monitoring, and management of multiple pregnancies. Ultrasound remains the corner- stone imaging modality due to its safety, accessibility, and real-time imaging capability. It is indis- pensable in determining chorionicity, detecting congenital anomalies, and assessing fetal growth and wellbeing. Advanced modalities, including high-resolution ultrasound, 3D/4D imaging, Dop- pler, and fetal MRI, have further enhanced diagnostic accuracy, enabling early detection and guided interventions such as fetoscopic laser ablation and intrauterine transfusion. Although the use of ionizing modalities like CT and X-ray is limited due to teratogenic risks, they remain essential in maternal life-threatening emergencies. The integration of artificial intelligence (AI) into radiologic imaging promises greater precision, automation, and predictive power in future obstetric care. Keywords: Multiple Pregnancy, Twin to Twin Syndrome, Doppler, Ultrasound. References 1. Kazandi, M. and Turan, V. (2011) “Multipl Pregnancies and Their Complications,” Journal of Turkish Society of Obstetric and Gynecology, 8(1), pp. 21–24. Available at: https://doi.org/10.5505/ tjod.2011.47704. 2. Arrowsmith, S. (2023) “Multiple pregnancies, the myometrium and the role of mechanical factors in the timing of labour,” Current Research in Physiology, 6. Available at: https://doi.org/10.1016/j. crphys.2023.100105. 3. Santana, D.S., Surita, RG. and Cecatti, J.G. (2018) "Multiple pregnancy: Epidemiology and association with maternal and perinatal morbidity" Revista Brasileira de Ginecologia e Obstetricia. Georg Thieme Verlag. pp. 554-562. Available at: https://doi.org/10.1055/s-0038-1668117. 4. Omonkhua, A.A., Okonofua, EE., Ntoimo, LEC, Aruomaren, A.L., Ade- bayo, A.M. and Nwuba, R., 2020. Community perceptions on causes of high dizygotic twinning rate in Igbo-Ora, South-west Nigeria A qualitative study. PLOS ONE, 15(12), p.e0243169. https://doi. org/10.1371/journal.pone.0243169. 5. Igbodike, EP, Ijarotimi, O.A., Ubom, A.E., Eleje, G.U., God'swill, CC., Okpala, BC, Nwaogu, N.L., Ajenifuja, KO, Ikechebelu, J.L, Loto, OM, Onwudiegwu, U., Eke, AC, 2024. Trends and outcomes of twin births in Southwest Nigeria: A 14-year retrospective cohort study. Exploratory Research in Hypothesis Medicine, 9(1), pp.15-24. https://doi.org/10.14218/ERHM.2023.00039. 6. Olotu, P.N., Olotu, LA, Yakubu, N.S., Onche, E.U., Famojuro, T.I., Datok, T., et al, 2023. A review of Nigerian plants and their bioactive constituents that increase chances of multiple pregnancies. Journal of Pharmacognosy and Phytochemistry, 12(4), pp.1-4. https:// dolorg/10.22271/phyto 2023.v1214c.14685. 7. Lazarov, S., Lazarov, L. and Lazarov, N. (2016) "Complications of multiple pregnancies. Overview," Trakia Journal of Science, 14(1), pp. 108-111. Available at: https://doi.org/10.15547/tjs.2016.01.016 8. Oblechina, NJ, Okolie, V., Eleje, G, Okechukwu, Z. and Anemeje, O., 2011. Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital. International Journal of Women's Health, 3, pp.227-230. https:// doLorg/10.2147/IJWHS22059 9. Ananth, C.V. and Chauhan, S.P, 2012. Epidemiology of twinning in developed countries. Seminars in Perinatology, 36(3), pp.156-161. https://doi.org/10.1053/semper.2012.02.001. 10. Matthews, TJ., MacDorman, M.F. and Thoma, M.E., 2015. Infant mortality statistics from the 2013 period linked birth/infant death data set. National Vital Statistics Reports, 64, pp.1-30. 11. National Institute for Health and Clinical Excellence, 2011. Multiple Pregnancy: The Management of Twin and Triplet Pregnancies in the Antenatal Period. [online] Available at: https://www.nice.org. uk/guidance/cg129 [Accessed 10 January 2017]. 12. Bellizzi, S., Sobel, H., Betran, A.P. and Temmerman, M., 2018. Early neonatal mortality in twin pregnancy: findings from 60 low- and middle-income countries. Journal of Global Health, 8, p.010404. 13. Roman, A., Ramirez, A. and Fox, N.S., 2022. Prevention of preterm birth in twin pregnancies. American Journal of Obstetrics & Gynecology MFM, 4, p.100551. 14. Trevett, T. and Johnson, A., 2005. Monochorionic twin pregnancies. Clinical Perinatology, 32(2), pp.475-494, vill. https://doi. org/10.1016/j.cp.2005.02.007. 15. Gyamfifi, C., Stone, J. and Eddleman, KA, 2005. Maternal complications of multifetal pregnancy. Clinical Perinatology, 32(2), pp.431-442, vii. https://doi.org/10.1016/j.clp.2005.02.004. 16. Coonrod, D.V, Hickok, D.E., Zhu, K., Easterling, TR. and Daling, J.R., 1995. Risk factors for preeclampsia in twin pregnancies: a population-based cohort study. Obstetrics & Gynecology, 85(5 Pt 1), pp. 645-650. https://doi.org/10.1016/0029-7844(95)00049-W. 17. Sibai, B.M., Hauth, J. Caritis, S, et al, 2000. Hypertensive disorders in twin versus singleton gestations. American Journal of Obstetrics and Gynecology, 182(4), pp.938-942. https://doi.org/10.1016/ S0002-9378(00)70350-4. 18. Cunningham, F.G., Leveno, K.J., Bloom, S.L., Hauth, J.C., Gilstrap, L. III and Wenstrom, K.D., 2005. Multifetal gestation. In: Cunningham, FG., Leveno, K.J., Bloom, S.L., Hauth, J.C., Gilstrap, L. III and Wenstrom, K.D. (eds.) Williams Obstetrics. 22nd ed. New York, NY: McGraw-Hill, pp. 911-948. 19. Kwan, M., Miglioretti, D., Marlow, E., Aiello Bowles, E.J., Weinmann, S.Y., Cheng, S., et al., 2019. Trends in medical imaging during pregnancy in the United States and Ontario, Canada, 1996 to 2016. JAMA Network Open, 2, p.e197249. 20. Bourgioti, C. et al. (2021) "Imaging during pregnancy: What the radiologist needs to know," Diagnostic and Interventional Imaging. Elsevier Masson s.r.l., pp. 593-603. Available at: https://doi. org/10.1016/j.diii.2021.05.003. 21. Ahn, H. (2025) "Imaging in Acute Obstetric Conditions: A Pictorial Essay," Korean Journal of Radiology, 26(5). Available at: https://doi. org/10.3348/kjr.2025.0037. 22. Tirada, N., Dreizin, D., Khati, N.J., Akin, E.A. and Zeman, R.K., 2015. Imaging pregnant and lactating patients. Radiographics, 35, pp.1751-1765. 23. Malinowski, A.K., Sen, J. and Sermer, M., 2015. Hyperreactio luteinalis: maternal and fetal effects. Journal of Obstetrics and Gynaecology Canada, 37, pp.715-723 24. Ganer Herman, H., Kogan, Z., Tairy, D., Ben Zvi, M., Kerner, R., Ginath, S., et al., 2018. Pregnancies following hysteroscopic removal of retained products of conception after delivery versus abortion. Gynecologic and Obstetric Investigation, 83, pp.586-592. 25. Yu, F.N.Y. and Leung, K.Y., 2021. Antenatal diagnosis of placenta accreta spectrum (PAS) disorders. Best Practice & Research Clinical Obstetrics & Gynaecology, 72, pp.13-24. 26. Gopireddy, D.R., Virarkar, M., Kumar, S., Vulasala, S.S.R., Nwachukwu, C. and Lamsal, S., 2022. Acute pelvic pain: a pictorial review with magnetic resonance imaging. Journal of Clinical Imaging Science, 12, p.48. 27. Mullany, K., Minneci, M., Monjazeb, R. and Coiado, O., 2023. Overview of ectopic pregnancy diagnosis, management, and innovation. Women's Health (London), 19, p.17455057231160349 28. Licci, M., Guzman, R., Soleman, J., 2019. Maternal and obstetric complications in fetal surgery for prenatal myelomeningocele repair: a systematic review. Neurosurgical Focus, 47(4), E11. 29. Corroenne, R., Yepez, M., Barth, J., et al., 2020. Chorioamniotic membrane separation following fetal myelomeningocele repair: incidence, risk factors and impact on perinatal outcome. Ultrasound in Obstetrics & Gynecology, 56(5), pp.684-693. 30. Jha, P. et al. (2021) "Role of imaging in obstetric interventions: Criteria, considerations, and complications," Radiographics, 41(4), pp. 1243-1264. Available at: https://doi.org/10.1148/ rg.2021200163. 31. Jelin, E., Hirose, S., Rand, L., et al., 2010. Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Fetal Diagnosis and Therapy, 27(3), pp.138-141. 32. Johnson, M.P. and Wilson, R.D., 2017. Shunt-based interventions: why, how, and when to place a shunt. Seminars in Fetal & Neonatal Medicine, 22(6), pp.391-398. 33. Crystal, M.A. and Freud, L.R., 2019. Fetal aortic valvuloplasty to prevent progression to hypoplastic left heart syndrome in utero. Birth Defects Research, 111(8), pp.389-394. 34. Bamberg, C. and Hecher, K., 2019. Update on twin-to-twin transfusion syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology, 58, pp.55-65. 35. Abbasi, N., Cortes, M.S., Ruano, R., et al., 2020. Bamberg, C. and Hecher, K., 2019. Update on twin-to-twin transfusion syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology, 58, pp.55-65. 36. Ishan Kumar. Evolution of Obstetric Sonography. CRIJ [Internet]. 2017 Feb. 22(1):1-2. Available from: https://medwinpublisher. org/index.php/CRIJ/article/view/1736 37. Douglas A, Daniel A, Veluri S. History of the Ultrasound Machine in Obstetrics and Gynecology. Academic Medicine & Surgery. Published online March 20, 2024. doi:10.62186/001c.115458 38. Campbell S. A short history of sonography in obstetrics and gynaecology. Facts Views Vis Obgyn. 2013;5(3):213-229 39. Salomon, L. J., Alfirevic, Z., Berghella, V., et al. (2019). ISUOG practice guidelines: Ultrasound in pregnancy. Ultrasound in Obstetrics & Gynecology, 53(6), 715-723. 40. World Health Organization (W

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.