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Obstetrics & Gynecology 1996;88:6-9
© 1996 by The American College of Obstetricians and Gynecologists
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Articles

Evaluation of the twin peak or lambda sign in determining chorionicity in multiple pregnancy

SL Wood, R St Onge, G Connors, and PD Elliot

OBJECTIVE: To assess prospectively the diagnostic capabilities of ultrasound assessment, using the twin peak or lambda sign, in determining chorionicity in multiple pregnancy. METHODS: Fifty-five cases of multiple pregnancy were assessed. Real-time ultrasound scans of the origin of the inter-twin membrane for the presence or absence of the twin peak/lambda sign were performed and permanent images recorded. Chorionicity was determined by placental pathologic analysis. RESULTS: Presence or absence of the twin peak/lambda sign as determined by real-time ultrasound correctly predicted chorionicity in 34 of 36 dichorionic and seven of eight monochorionic twin pregnancies: sensitivity for dichorionicity 94%, specificity 88%, positive predictive value 97%, and negative predictive value 78%. Real-time assessment was superior to analysis of permanent films. CONCLUSION: Ultrasound assessment of chorionicity using the twin peak/lambda sign has high sensitivity and specificity, but accuracy may not be sufficient to guide clinical management in all cases.


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