Placental pathophysiology of the twin oligohydramnios-polyhydramnios sequence and the twin-twin transfusion syndrome

Bruner, Joseph P.; Anderson, Ted L.; Rosemond, Richard L.

doi:10.1016/s0143-4004(98)90102-3

Cited by 52 publications

(23 citation statements)

References 12 publications

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“…In the current study, the prognosis for growth-retarded twins complicated by TTTS was closely associated with preterm delivery as previous studies reported [1,12].…”

Section: Discussionsupporting

confidence: 76%

Fetal Middle Cerebral Artery Doppler Waveforms in Twin–Twin Transfusion Syndrome

Suzuki

Sawa²,

Yoneyama³

et al. 1999

Gynecol Obstet Invest

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The aim of this study was to compare the fetal middle cerebral artery (MCA) Doppler waveforms in growth-retarded twin fetuses with (n = 11) and without (n = 24) twin–twin transfusion syndrome (TTTS). Umbilical artery (UA) and fetal MCA Doppler velocity waveforms were recorded on admission. The mean values of the UA pulsatility index (PI) of smaller twin fetuses with and without TTTS were significantly higher than those of normal singleton pregnancies. The mean values of the MCA PI of smaller twin fetuses in the TTTS group (+0.7 ± 1 SD) were significantly higher than those of normal singleton pregnancies on admission, and these levels did not markedly change following amniocentesis. On the other hand, the values of the MCA of the growth-retarded fetuses without TTTS (–0.9 ± 1 SD) were significantly lower than those of normal singleton pregnancies. Our findings suggest that measurement of fetal MCA PI is a useful method to assess growth-retarded fetuses in monochorionic twin pregnancies.

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“…In the current study, the prognosis for growth-retarded twins complicated by TTTS was closely associated with preterm delivery as previous studies reported [1,12].…”

Section: Discussionsupporting

confidence: 76%

Fetal Middle Cerebral Artery Doppler Waveforms in Twin–Twin Transfusion Syndrome

Suzuki

Sawa²,

Yoneyama³

et al. 1999

Gynecol Obstet Invest

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“…Hence, the placenta may expand from unfavourable areas towards positions with better nourishment conditions. However, in this laterally growing placental tissue, the umbilical cord remains at its original location, turning an initially centrally inserted cord into a marginal or velamentous insertion (Robinson, 1983;Heinonen et al, 1996;Bruner et al, 1998;Loos et al, 2001;Benirschke and Kaufman, 2006). Evidence for this trophotropism theory is also found in the occasional migration of an early diagnosed placenta praevia to higher situated places in the uterus while the opposite never occurs (Benirschke and Kaufman, 2006).…”

Section: Discussionmentioning

confidence: 99%

Umbilical cord anomalies are more frequent in twins after assisted reproduction

et al. 2007

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BACKGROUND: The objective of this study is to analyse differences in cord characteristics between naturally conceived twins and twins born after assisted reproduction. METHODS: Between 1985 and 2004, the East Flanders Prospective Twin Survey (EFPTS) registered 4159 twin pairs. We compared cord characteristics between 2119 naturally conceived dizygotic (DZ) twin members and 2243 DZ twin members originating from assisted reproductive technologies (ART). Data were adjusted for intra-twin correlation, year of birth, maternal age, gestational age, parity, sex of the child and number of placentas. RESULTS: Marginal cord insertion, velamentous cord insertion and single umbilical artery (SUA) occur more frequently in twins following infertility treatment (P < 0.001). The incidence of velamentous cord insertion increases proportionate with 'invasiveness' of reproductive techniques: 3.6% in naturally conceived twins versus 5% in twins after artificial induction of ovulation (AIO) [odds ratio (OR) 1.45; 95% confidence interval (CI) 0.99-2.11], 7.4% in twins after IVF (OR 1.49; 95% CI 1.26-1.77) and 10.4% in twins after ICSI (OR 1.31; 95% CI 1.14-1.51). SUA has the highest incidence in twins after AIO: 1.9% compared with 0.6% in naturally conceived twins (OR 3.19; 95% CI 1.66-6.11). CONCLUSIONS: Umbilical cords of twins born after ART have more pathologic characteristics when compared with cords of naturally conceived twins.

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“…TTTS was diagnosed using an ultrasound examination when cases of monochorionic diamniotic multiples defined at the first trimester showed both polyhydramnios of the maximum vertical pocket ≥ 8 cm in one sac and oligohydramnios of the maximum vertical pocket ≤ 2 cm in the other sac (Bruner et al 1998). Sepsis was defined as systemic inflammatory response syndrome (SIRS) in response to an infectious process.…”

Section: Definitionsmentioning

confidence: 99%

Renal Vasodilatory Action of Arginine Vasopressin in Extremely Low Birth Weight Infants

Kaga

Matsuda

Watanabe

et al. 2013

Tohoku J. Exp. Med.

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In extremely low birth weight (ELBW) infants, systemic hypotension is associated with poor neurological outcomes as a result of cerebral hypoperfusion. Treatment with arginine vasopressin (AVP) has been shown to increase blood pressure (BP) and urine output in ELBW infants suffering from refractory hypotension. The purpose of this study was to clarify whether low doses of AVP increased renal blood flow (RBF) in ELBW infants. We retrospectively analyzed data from the medical charts describing nine AVP infusions at 0.3-0.8 mU/kg/min in four ELBW infants. The median gestational age was 23 (22.5-23.5, interquartile range) weeks, and the median birth weight was 466 (414-563) g. Changes in the heart rate, BP, urine output, and RBF velocity patterns in response to the AVP infusions were compared using statistical analyses. The AVP infusion caused significant increases in systolic BP from 44 (41.0-47.0) to 50 (42.5-55.5) mmHg, diastolic BP from 17 (15.0-26.5) to 31 (28.5-33.0) mmHg, mean BP from 26 (24.5-30.5) to 36 (34.5-40.5) mmHg, and urine output from 1.4 (0.2-2.5) to 2.8 (1.0-8.6) mL/kg/hr. We also observed significant decreases in the resistance index from 1.0 (0.96-1.0) to 0.8 (0.71-0.91) and peak systolic flow velocity in the renal artery from 40 (27.2-50.6) to 28 (16.0-28.9) cm/s after AVP infusions. AVP infusions at 0.3-0.8 mU/kg/min in ELBW infants appeared to significantly increase the RBF by inducing renal vascular dilation and increasing the BP. Increasing the RBF most likely induces an increase in the glomerular filtration rate, resulting in the diuretic effect of AVP.Keywords: arginine vasopressin; diuretic effect; extremely low birth weight infants; renal blood flow; renal vasodilation Tohoku J. Exp. Med., 2013 November, 231 (3), 159-164.

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Placental pathophysiology of the twin oligohydramnios-polyhydramnios sequence and the twin-twin transfusion syndrome

Cited by 52 publications

References 12 publications

Fetal Middle Cerebral Artery Doppler Waveforms in Twin–Twin Transfusion Syndrome

Fetal Middle Cerebral Artery Doppler Waveforms in Twin–Twin Transfusion Syndrome

Umbilical cord anomalies are more frequent in twins after assisted reproduction

Renal Vasodilatory Action of Arginine Vasopressin in Extremely Low Birth Weight Infants

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