Correlation between cord insertion type and chorionic villus vascularization of the co-twin in diamniotic–monochorionic twin pregnancies

Chu, Sharon; Mao, Quanfu; Shapiro, Steven K.; Luks, Sophie; Paepe, Monique E. De

doi:10.1016/j.earlhumdev.2013.01.009

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…A total of 10 studies reported birthweight as an outcome in VCI cases: 2 studies reported birthweight in twin pregnancies with VCI [58,61], 3 looked at the proportion of VCI infants with low birthweight [7,40,62] and 7 examined the relative risk of infants being small for gestational age (SGA) at birth between VCI and non-VCI singleton or twin pregnancies [4,7,8,42,44,47,62]. In general, the evidence suggests a relationship between VCI pregnancies and the infants being SGA or having a low birthweight (Fig.…”

Section: Low Birthweight and Infants Small For Gestational Agementioning

confidence: 99%

“…However, the evidence from studies on twin pregnancies was less clear. The 2 studies evaluating birthweight of infants reported this to be significantly lower among twins from pregnancies with VCI; however, they were either delivered pre-term or the gestational age at birth was not specified, which limits the generalisability of the results [58,61]. The incidence of SGA infants was generally reported to be greater in twins from VCI pregnancies [42,44,47].…”

Section: Low Birthweight and Infants Small For Gestational Agementioning

confidence: 99%

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Velamentous cord insertion: results from a rapid review of incidence, risk factors, adverse outcomes and screening

Buchanan-Hughes

Bobrowska

Visintin³

et al. 2020

Syst Rev

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Background: Velamentous cord insertion (VCI) is an umbilical cord attachment to the membranes surrounding the placenta instead of the central mass. VCI is strongly associated with vasa praevia (VP), where umbilical vessels lie in close proximity to the internal cervical os. VP leaves the vessels vulnerable to rupture, which can lead to fatal fetal exsanguination. Screening for VP using second-trimester transabdominal sonography (TAS) to detect VCI has been proposed. We conducted a rapid review investigating the quality, quantity and direction of evidence available on the epidemiology, screening test accuracy and post-screening management pathways for VCI. Methods: MEDLINE, Embase and the Cochrane Library were searched on 5 July 2016 and again on 11 October 2019, using general search terms for VP and VCI. Only peer-reviewed articles reporting on the epidemiology of VCI, the accuracy of the screening test and/or downstream management pathways for VCI pregnancies were included. Quality and risk of bias of each included study were assessed using pre-specified tools. Results: Forty-one relevant publications were identified; all but one were based on non-UK pregnancy cohorts, and most included relatively few VCI cases. The estimated incidence of VCI was 0.4-11% in singleton pregnancies, with higher incidence in twin pregnancies (1.6-40%). VCI incidence was also increased among pregnancies with one or more other risk factors, including in vitro fertilisation pregnancies or nulliparity. VCI incidence among women without any known risk factors was unclear. VCI was associated with adverse perinatal outcomes, most notably pre-term birth and emergency caesarean section in singleton pregnancies, and perinatal mortality in twins; however, associations varied across studies and the increased risk was typically low or moderate compared with pregnancies without VCI. In studies on limited numbers of cases, screening for VCI using TAS had good overall accuracy, driven by high specificity. No studies on post-screening management of VCI were identified. Conclusions: Literature on VCI epidemiology and outcomes is limited and low-quality. The accuracy of secondtrimester TAS and the benefits and harms of screening cannot be determined without prospective studies in large cohorts. Modelling studies may indicate the feasibility and value of studying the epidemiology of VCI and the potential impact of detecting VCI as part of a population screening programme for VP.

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Section: Low Birthweight and Infants Small For Gestational Agementioning

confidence: 99%

Section: Low Birthweight and Infants Small For Gestational Agementioning

confidence: 99%

Velamentous cord insertion: results from a rapid review of incidence, risk factors, adverse outcomes and screening

Buchanan-Hughes

Bobrowska

Visintin³

et al. 2020

Syst Rev

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“…La IVCU no se ha asociado a distribución placentaria asimétrica ni a mayor número de anastomosis placentarias en embarazos con pesos discordantes o concordantes. Se entiende por ello que cualquier contribución funcional de la inserción velamentosa de cordón umbilical a la discordancia de pesos al nacer no está relacionada a la angioarquitectura vascular placentaria ni a la falta de balance arteriovenoso (24) . Es, quizás por esta razón que la IVCU no está asociada con mayor riesgo de desarrollar el síndrome de transfusión feto-fetal (STFF).…”

Section: Inserción Velamentosa Del Cordón Umbili-calunclassified

Angioarquitectura placentaria y los orígenes de la patología monocorial

Paredes¹,

Gómez²

2015

Rev peru ginecol obstet.

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Los gemelos coriangiopagos (fetos que comparten una placenta) pueden tener de manera exclusiva asimetría en la distribución de territorios placentarios, con alta incidencia de inserción marginal y algunas veces en velamento del cordón umbilical; además, transfusiones interfetales (agudas o crónicas) que se producen por la presencia de comunicaciones sanguíneas (anastomosis placentarias). Resulta así una serie de fenotipos fetales que solo se presentan en este tipo de embarazos, en orden de frecuencia, el síndrome de transfusión feto-fetal, restricción del crecimiento intrauterino selectivo, síndrome de anemia-policitemia y la secuencia arterial reversa (twin reversed arterial perfusion - TRAP), pudiendo coexistir más de uno en un mismo embarazo. Es importante entonces el estudio de la angioarquitectura placentaria en los gemelos monocoriónicos, para comprender el comportamiento y el fenotipo que resultara en cada embarazo.

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“…Endoglin is an important angiogenic regulator implicated in the pathogenesis of preeclampsia and intrauterine growth restriction (IUGR) in singleton pregnancies (reviewed by Kusanovic and coauthors [33]). Interestingly, velamentous cord insertion of one monochorionic twin may affect not only its own vascular distribution pattern but choriovascular angiogenesis of the co-twin as well [41,42]. These recent findings suggest that the pathophysiology of monochorionic twinning, and of TTTS in particular, is likely even more complex than hitherto suspected, as the mutual effects of the co-twins on each other's cardiovascular systems remain relatively unexplored.…”

Section: Placental Contributions: Cord Insertion and Placental Sharingmentioning

confidence: 99%

What—and Why—the Pathologist Should Know about Twin-to-Twin Transfusion Syndrome

Paepe

Luks

2013

Pediatr Dev Pathol

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Approximately 20% of all twin pregnancies are monochorionic. Between 9% and 15% of all monochorionic twin gestations are complicated by severe chronic twin-to-twin transfusion syndrome (TTTS), characterized by a gradual shift of blood volume from the donor twin to the recipient twin through placental vascular connections [1 - 3] . The prognosis of severe, untreated chronic TTTS diagnosed in midtrimester fetuses is extremely poor, with mortality rates exceeding 70% [4] . Since publication of the results of the Eurofoetus trial in 2004, laser photocoagulation of the intertwin anastomoses has become accepted as the optimal first-line therapy for severe TTTS diagnosed before 26 weeks of gestation. While laser treatment of vascular communications was initially limited to selected fetal treatment centers, its increasingly widespread use has resulted in the exposure of more pathologists, even in less specialized institutions, to laser-treated placentas. Furthermore, the surge in laser coagulation has revived the general medical, scientific, and public interest in the placental and choriovascular findings in monochorionic twin placentas. The pathologist's understanding of the pathophysiology of TTTS and of TTTS-associated placental pathology, including the findings related to laser ablation of the anastomoses, can be of great benefit to the involved obstetric/neonatal/surgical team and, ultimately, to the patients. In this review, we summarize the current knowledge of the placental contributions to TTTS and other complications of monochorionic twinning and describe the strengths and limitations of placental examination in these settings. It is our expectation that overviews such as this may serve as a template to generate consensus guidelines for standardized and evidence-based pathologic evaluation of monochorionic twin placentas.

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Correlation between cord insertion type and chorionic villus vascularization of the co-twin in diamniotic–monochorionic twin pregnancies

Cited by 8 publications

References 23 publications

Velamentous cord insertion: results from a rapid review of incidence, risk factors, adverse outcomes and screening

Velamentous cord insertion: results from a rapid review of incidence, risk factors, adverse outcomes and screening

Angioarquitectura placentaria y los orígenes de la patología monocorial

What—and Why—the Pathologist Should Know about Twin-to-Twin Transfusion Syndrome

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