Ultrasound examination of fetal morphology, trimester II-III, multiple pregnancy, with Doppler (photos included)

Fetal morphological ultrasound in the second and third trimesters in the context of a multiple pregnancy, with Doppler assessment, is an advanced, non-invasive imaging method that is essential for the differentiated monitoring of each fetus, placental condition and fetoplacental circulation. The examination is particularly recommended in twin or higher-order multiple pregnancies, as it allows early detection of complications specific to these pregnancies.

Structures assessed:

• Each fetus — individual fetal biometry, estimated weight, position, activity and anatomical morphology.
• Placenta/placentas — location, appearance, degree of maturation and distribution between the fetuses.
• Umbilical cord — assessment for each fetus, insertion site and number of vessels.
• Blood flow — assessed by Doppler in the uterine arteries, umbilical arteries, middle cerebral artery, ductus venosus and fetal aorta.
• Amniotic fluid — assessed separately for each amniotic sac.
• Uterus and adnexal structures — as part of the overall assessment.

Purpose of the examination

• Monitoring the individual development of each fetus in multiple pregnancies.
• Assessment of the function of a single placenta or separate placentas and the appropriate distribution of fetal resources.
• Detection of complications such as:
  • Selective fetal growth restriction (sFGR)
  • Twin-to-twin transfusion syndrome (TTTS)
  • Biometric discrepancy between fetuses
  • Placental hypoperfusion or risk of preterm birth
• Guiding obstetric management according to the condition of each fetus.

Indications

• Confirmation of a multiple pregnancy, including twins, triplets, etc.
• Differences in fetal development or suspected pregnancy-specific complications.
• Assessment as part of an intensive prenatal monitoring protocol.
• Obstetric history including:
  • Intrauterine fetal death,
  • Fetal growth restriction,
  • Pregnancy complicated by pre-eclampsia.
• Determining the optimal timing of delivery or medical intervention.

Procedure

The patient is examined in a lying position. The physician applies ultrasound gel to the abdomen and uses an ultrasound probe to assess each fetus individually, the placenta or placentas and circulatory parameters. Morphological measurements are performed and Doppler blood flow is assessed and recorded; relevant images may be archived. The examination takes approximately 40–50 minutes, depending on the number of fetuses and the complexity of the assessment.

Fetal morphological ultrasound with Doppler in the second and third trimesters in the context of a multiple pregnancy is an essential examination for accurate and differentiated monitoring of each fetus. It enables early detection of complications and supports timely medical decision-making to protect maternal and fetal health.

Medical sources:

https://www.ncbi.nlm.nih.gov/books/NBK570574/
https://pmc.ncbi.nlm.nih.gov/articles/PMC6243450/
https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.29166
https://www.glowm.com/article/heading/vol-18--ultrasound-in-obstetrics--ultrasound-evaluation-of-multiple-gestation/id/419333
https://fetalmedicine.org/var/uploads/Doppler-in-Obstetrics.pdf
https://radiologykey.com/multiple-pregnancy-and-doppler-ultrasound/