Placental anastomoses in monochorionic diamniotic twin pregnancy: not always a source of complication

Bolla, Daniele; Favre, D; Spinelli, Marialuigia; Baud, David; Baumann, Marc; Raio, Luigi

doi:10.1002/uog.15822

Cited by 1 publication

(1 citation statement)

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“…It has also been proposed that the number and nature of placental vascular anastomoses are central to the development of TTTS. However, a number of studies have reported that placental vascular anastomoses can be demonstrated in the vast majority of monochorionic twin pregnancies, with and without TTTS. Thus, other mechanisms of disease are probably operating in TTTS.…”

Section: Discussionmentioning

confidence: 99%

Association between impedance to blood flow in umbilical arteries and infant survival in twin‐to‐twin transfusion syndrome

Espinoza

Belfort

Shamshirsaz

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To evaluate infant survival according to the Doppler pattern of impedance to blood flow in the umbilical arteries (UAs) prior to laser surgery, in pregnancies with twin‐to‐twin transfusion syndrome (TTTS). Methods This was a retrospective study of women with a monochorionic diamniotic twin pregnancy who underwent laser surgery for TTTS between January 2012 and May 2018 at a single institution. Absolute intertwin difference in UA pulsatility index (DUAPI) was measured within 48 h prior to laser surgery. Twins with intermittent or persistent absent/reversed end‐diastolic flow (EDF) in the UA (UA‐EDF) were analyzed separately. Survival of both or at least one infant at birth and at 30 days postpartum was compared between pregnancies with an intertwin DUAPI of ≥ 0.4 and those with an intertwin DUAPI of < 0.4, as well as between fetuses with intermittent and those with persistent absent/reversed UA‐EDF. Parametric and non‐parametric tests were used for analysis. Regression analysis was performed to determine if intertwin DUAPI and intermittent or persistent absent/reversed UA‐EDF were associated independently with infant survival, while controlling for gestational age at delivery, Quintero stage and other important confounding variables. Results Of 231 TTTS pregnancies that underwent laser surgery during the study period, UA Doppler information could be retrieved for 206 and delivery information was available for 184, which comprised the study population. Rates of double‐twin survival at birth were significantly higher in pregnancies with an intertwin DUAPI of < 0.4 than in those with an intertwin DUAPI of ≥ 0.4 (83.9% (78/93) vs 50.0% (12/24); P < 0.001). Double‐infant survival at birth was higher in pregnancies with intermittent compared to those with persistent absent/reversed UA‐EDF (73.0% (27/37) vs 36.7% (11/30); P = 0.003). Regression analysis demonstrated that an intertwin DUAPI of < 0.4 was associated with increased survival of both twins at delivery (P < 0.001) and at 30 days postpartum (P = 0.002), as well as increased survival of at least one twin at delivery (P = 0.009). Similarly, intermittent absent/reversed UA‐EDF was associated with increased survival of both twins at delivery (P = 0.007) and at 30 days after birth (P = 0.015). Conclusions Evaluation of intertwin differences in UA impedance to blood flow as well as identification of intermittent or persistent absent or reversed UA‐EDF prior to laser surgery could help in the prediction of double‐infant survival at birth and to 30 days in twin pregnancies with TTTS. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 99%