This online self-paced course will address the role of ultrasound in the care of twin pregnancies complicated by a shared placenta such as selective fetal growth restriction(sFGR), twin to twin transfusion syndrome (TTTS), twin anemia–polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence, and monoamniotic twins.
Overview
Course name: ATC6 Complications of monochorionicity
Duration of course: 9 hours (+ supplementary materials)
Length of access for each course: 12 months
Certificates: 9 CME credits and ISUOG Certificate of Completion
Access: Online learning, learn at your own pace.
Education level: Advanced
Program language: English
Suitable for: Practicing obstetricians, trainees, fellows, residents, radiographers, sonographers, GPs and healthcare professionals performing ultrasound scans.
Why do this course?
Twin and pregnancy is associated with a high risk of perinatal mortality and morbidity. In 2009, the associated stillbirth rate was 12 per 1000 twin births and 31 per 1000 triplet and higher-order multiple births, compared with five per 1000 singleton births. Ultrasound assessment of fetal biometry, anatomy, Doppler velocimetry and amniotic fluid volume is used to identify and monitor twin pregnancies at risk of adverse outcomes such as twin-to-twin transfusion syndrome and fetal growth restriction. As in singletons, impaired fetal growth can be assessed in twins by comparing biometry and Doppler velocimetry parameters against standards for uncomplicated pregnancy.
Course description
This course will explore the crucial role of ultrasound in managing twin pregnancies complicated by a shared placenta. It will cover conditions such as selective fetal growth restriction (sFGR), where one twin grows at a slower rate than the other, and twin-to-twin transfusion syndrome (TTTS), a serious condition where blood flows unevenly between the twins through the placenta. Additionally, the course will address twin anemia-polycythemia sequence (TAPS), characterized by a disparity in red blood cell counts between the twins, and twin reversed arterial perfusion (TRAP) sequence, a rare disorder where one twin is underdeveloped and receives blood from the other twin.
The course will also delve into the complexities of managing monoamniotic twins, who share both the placenta and the amniotic sac, posing significant risks such as cord entanglement. Through detailed discussions and case studies, participants will learn how to utilize ultrasound effectively to monitor and intervene in these high-risk scenarios, ensuring better outcomes for both mothers and their twins.
Contributors to this course
Online course contributors: Andrew Cowling, Angela Ranzini, Lina Youssef
Course materials: Prof. Asma Khalil, Dr. Eduard Gratacos, Prof. Julien Stirnemann, Prof. Jon Hyett, Prof. Yves Ville, Dr. Magda Sanz-Cortes, Prof. Kurt Hecher, Prof. Kyprianos Nicolaides, Prof. Monique Haak, Dr. Femke Slaghekke, Dr. Anthony Johnson, Prof. Liesbeth Lewi, Prof. Lawrence Platt, Dr. Denise Pugash, Prof Daniela Prayer, Dr. Hiba Mustafa, Dr. Rogelio Cruz Martinez, Dr. Dick Oepkes, Prof. Hye-Sung Won, J. Miranda, J. P. Comas; M. Fernandez; Y. Marques, R. Cruz-Martínez, R. Villalobos-Gómez, C. J. Gaona-Tapia, E. Krispin, D. Di Mascio, S. Sorrenti, ISUOG Practice Guidelines: role of ultrasound in twin pregnancy, ISUOG Practice Guidelines (updated): performance of fetal magnetic resonance imaging.
Learning objectives
- Discern diverse growth restriction patterns in Monochorionic pregnancies and devise optimal management strategies.
- Master the diagnostic techniques for twin-to-twin transfusion syndrome and identify appropriate intervention timings.
- Recognize individuals susceptible to twin anemia-polycythemia sequence, and proficiently manage identification and treatment protocols.
- Grasp the mechanism of twin reversed arterial perfusion sequence and implement effective therapeutic approaches.
- Acquire insight into potential complications arising from monoamniotic twins and develop proficient management strategies.
Key questions
- How do we diagnose and manage sFGR in monochorionic multiples?
- How do we diagnose, manage, and treat the complications arising from a shared placenta; TTTS, TAPS, and TRAP?
- What are the complications arising from monochorionic monoamniotic twins and how are they managed?
Prices
Prices for ISUOG members
| ISUOG member | £75 |
| ISUOG member - with trainee/sonographer discount | £40 |
| ISUOG member in middle-income setting | £40 |
| ISUOG member in lower-resource setting | £10 |
Prices for ISUOG non-members*
| Non-member | £85 |
| Non-member - with trainee/sonographer discount | £50 |
| Non-member in middle-income setting | £50 |
| Non-member in lower-resource setting | £15 |
* Prices for non-members does NOT include ISUOG membership. Join as an ISUOG member first for discounted prices to our online training courses (allow 24 hours for systems to update).
Trainees/residents and sonographers/radiographers
Proof of status: All trainees, residents, sonographers and radiographers will need to submit proof of their trainee, resident, sonographer or radiographer status by way of a letter from their Department or Institution. The letter must be in English and dated within the last 3 months and submitted by email to [email protected] along with the name of the course you wish to purchase.
Sonographer definition: A sonographer is a non-physician medical imaging professional who performs diagnostic medical sonography, or diagnostic ultrasound.
Trainee/resident definition: A trainee is a medical professional who is not yet fully qualified or practicing without supervision within their chosen specialty and in accordance with the relevant national regulatory authorities; a resident is in residency training which leads to specially or subspecialty) certification.
Low resource country discount
ISUOG's mission is to disseminate the highest quality education to the broadest audience. To support this aim, we have ensured that attendees from low resource countries have the lowest purchase costs. ISUOG's low resource country list can be viewed here https://www.research4life.org/access/eligibility/.
No other discounts can be used in conjunction with this rate. These rates will appear automatically in the ISUOG Academy based on your membership details, or registered details. Please make sure these details are up to date.
Middle income country discount
ISUOG's mission is to disseminate the highest quality education to the broadest audience. To support this aim, we have ensured that attendees from middle income countries have access to reduced purchase costs. ISUOG has identified the following countries whose economies fall within the middle income category as defined by the World Bank: American Samoa, Argentina, Brazil, Bulgaria, China, Costa Rica, Dominican Republic , India, Indonesia, Iran, Kazakhstan, Malaysia, Mexico, Philippines, Russia, Serbia, South Africa, Thailand, Turkey, Turkmenistan.
No other discounts can be used in conjunction with this rate. These rates will appear automatically in the ISUOG Academy based on your membership details, or registered details. Please make sure these details are up to date.
Further information
Accreditation and CME Credits
CME credits
The European Accreditation Council (EACCME) accredits this online course for Continuing Medical Education (CME). European CME credits (ECMEC®) will be awarded on successful completion of this course. Through an agreement between the European Union of Medical Specialists (UEMS) and the American Medical Association (AMA), physicians may convert EACCME credits to an equivalent number of AMA PRA Category 1 CreditsTM. Information on the process to convert EACCME credit to AMA credit can be found at www.ama-assn.org/go/internationalcme.
CME Subcommittee
The CME Subcommittee oversees the CME requirements for our CME accredited courses.
Conflict of Interest
No commercial support has been accepted related to the development or publication of this course. This course underwent peer review in line with the standards of editorial integrity and publication ethics maintained by the International Society of Ultrasound in Obstetrics & Gynecology (ISUOG). Conflicts of interest have been identified and resolved in accordance with EACCME guidelines.
You can find out how we adhere to the essential criteria for EACCME accreditation requirements here.
Technical Requirements
You can study on your phone, tablet or laptop. To participate and access this activity you will need a good internet connection and an up to date browser:
- MS Internet Explorer 11 (Not including compatibility modes)
- MS Edge
- Mozilla Firefox version 60 Extended Support Release (ESR)
- Google Chrome 73
- Safari 10 auf OS X
- Mobile Browser Android >4 and iOS > 9
- Current versions of Adobe Reader plugin
Terms and Conditions
You can find our full Terms and Conditions, and Privacy Policy here.
You can find our Refund Policy here.
Obstetrics multiple pregnancy curriculum course list
Other courses in this series that are currently available:
ATC6 Ultrasound in twin pregnancy
ATC6 Management of Complicated Multiples