Placental types and twin-twin transfusion syndrome

Bermúdez, Carlos; Becerra, Carlos; Bornick, P. W.; Allen, Mary; Arroyo, Jorge Olmo; Quintero, Rubén A.

doi:10.1067/mob.2002.124280

Cited by 103 publications

(53 citation statements)

References 13 publications

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“…In contrast with this speculation is the fact that MC twins have placental weights that are higher than the MZ DC with fused placentas and are equal to DZ twins with fused placentas. This could be due to the presence of vascular anastomoses in MC placentas with a bidirectional blood flow which results in blood supply from the optimal vascular support towards the reduced vascular support (Bermudez et al, 2002). Explanations for heavier placentas in twins born to multipara are the facts that the uterus is heavier and more 'experienced' (Bleker et al, 1988) and that the amount of distension which the uterus will tolerate at a given period of pregnancy is higher in multipara than in primipara (Bleker et al, 1979).…”

Section: Figurementioning

confidence: 99%

Curves of Placental Weights of Live-Born Twins

Gielen¹,

Lindsey

Derom

et al. 2006

Twin Res Hum Genet

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The purpose of this study is to present curves of estimated placental growth in twins and to evaluate the relative contribution of gestational age, zygosity, chorionicity, fusion of the placentas, sex of the individual and of the twin pair, site of the umbilical cord insertion, birth order, maternal age, and parity. Perinatal data and placental data were obtained from 6315 live-born twin pairs from the East Flanders Prospective Twin Survey. Of 4318 twin pairs, with no missing values, the placental weights of different gestational ages were analyzed using a nonlinear multivariate Gaussian regression. Two groups were distinguished: (1) twins with two separate placentas, and (2) twins with only one placental mass (one placenta in case of monochorionic twins or two fused placentas in case of dichorionic placentas). Overall, placental weight was influenced by gestational age, fusion of the placentas, and parity. In the case of one placental mass, monozygotic dichorionic twins had the lowest weights. If two separate placentas were present, birth order played a role in favor of the first-born twin. For parity and zygosity, the differences were most pronounced between 27 and 29 weeks, whereas the difference for birth order was most pronounced between 33 and 37 weeks. In conclusion, basic physiological characteristics, routinely examined at birth, influence placental weight. Taking these covariates into account allows a better evaluation of the placental weight given a gestational age, as an indicator of growth.

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Section: Figurementioning

confidence: 99%

Curves of Placental Weights of Live-Born Twins

Gielen¹,

Lindsey

Derom

et al. 2006

Twin Res Hum Genet

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“…The basis for the development of TTTS is the development of AV/VA discordant flow [24]. In most cases, TTTS results from a predominance in the number and/or diameter of AV anastomoses from the donor to the recipient fetus [25].…”

Section: Chronic Feto-fetal Transfusion Syndromes: Ttts and Tapsmentioning

confidence: 99%

A Systematic Approach to the Differential Diagnosis and Management of the Complications of Monochorionic Twin Pregnancies

2012

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Monochorionic (MC) twins represent a significant proportion of perinatal morbidity and mortality. Overall, 1 of 3 MC twin pregnancies will develop complications in relation to the MC placenta and the presence of interfetal placental anastomoses. From a clinical standpoint, these complications can be grouped into four main types of clinical problems: chronic transfusion, acute transfusion, growth discordance, and discordant malformation. Differential diagnosis of MC twin complications is still challenging due to frequent overlap of their clinical signs and the complex relationships between them. Clinical experience demonstrates that most instances of wrong management derive from failure to comply with a basic set of rules for diagnosis and management. In this review, we propose a simplified approach to the understanding of MC twin pregnancy, its potential complications, and the key concepts allowing adequate differential diagnosis and targeted management.

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“…AV anastomoses can be identified by confirming a terminal end of the artery in one twin without a corresponding vein to the other twin; this finding is present at the immediate vicinity of the terminal end of the vein in the other twin. The incidence of cases without placental vascular anastomoses is approximately 4% according to previous studies on monochorionic placentas [6,7,8,9]. Among these cases, there were no cases complicated with TTTS that did not have vascular anastomoses.…”

Section: Discussionmentioning

confidence: 99%

Laser Therapy for Twin-Twin Transfusion Syndrome in the Absence of Fetoscopically Visible Placental Vascular Anastomoses

Ishii¹,

Taguchi²,

Yamamoto³

et al. 2013

Fetal Diagn Ther

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Fetoscopic laser photocoagulation (FLP) was performed at 22 weeks of gestation for a pregnancy complicated with twin-twin transfusion syndrome (TTTS) and an anterior placenta. However, vascular anastomoses could not be identified by the fetoscope. To dichotomize the circulation between the twins, the terminal ends of the paired artery and vein of the recipient twin were coagulated. In addition, a line was drawn with the laser connecting the dots, which had been coagulated. The Doppler waveform as well as the amniotic fluid volume of each twin normalized after the procedure. The twins were delivered by cesarean section subsequent to onset of labor at gestational week 30; the recipient twin weighed 1,350 g and the donor twin weighed 550 g. Both twins had a normal neurologic exam at 6 months of age. Patent placental vascular anastomoses could not be detected. This case demonstrates that vascular anastomoses in TTTS may not be identified by a fetoscope and that FLP to coagulate the entire vascular equator closer to the area of the recipient twin was effective in this rare situation.

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Placental types and twin-twin transfusion syndrome

Cited by 103 publications

References 13 publications

Curves of Placental Weights of Live-Born Twins

Curves of Placental Weights of Live-Born Twins

A Systematic Approach to the Differential Diagnosis and Management of the Complications of Monochorionic Twin Pregnancies

Laser Therapy for Twin-Twin Transfusion Syndrome in the Absence of Fetoscopically Visible Placental Vascular Anastomoses

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