Twin gestations are high risk pregnancies for a variety of reasons. In order
to perform a comprehensive assessment, knowledge of embryology and
classification of twins is a primary requirement. Familiarity with
sonographic findings of associated abnormalities is crucial. Each twin
gestation should be assessed according to three essential components in a
step-by-step algorithm designed to take into consideration every aspect of
the twinning phenomenon. It is imperative that the chorionicity and
amnionicity be determined as a first step. This is followed by a decision
about concordance or discordance of growth that can lead to alteration in
management. Because of the higher incidence of congenital anomalies, a much
more rigorous search for abnormalities should be undertaken. Increased
awareness of the unique circumstances surrounding twins can help decrease
their associated high mortality and morbidity.
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