Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome

Denbow, Mark L., Cox, Philip, Taylor, Myles, Hammal, Donna M. and Fisk, Nicholas M. (2000) Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. American Journal of Obstetrics and Gynecology, 182 2: 417-426. doi:10.1016/S0002-9378(00)70233-X


Author Denbow, Mark L.
Cox, Philip
Taylor, Myles
Hammal, Donna M.
Fisk, Nicholas M.
Title Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome
Journal name American Journal of Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0002-9378
1097-6868
Publication date 2000-02
Sub-type Article (original research)
DOI 10.1016/S0002-9378(00)70233-X
Volume 182
Issue 2
Start page 417
End page 426
Total pages 10
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Formatted abstract
OBJECTIVE:
We sought to correlate placental vasculature with fetal growth and outcome in monochorionic twins.

STUDY DESIGN:
Eighty-two patients with consecutive monochorionic pregnancies underwent biweekly ultrasonography for determination of fetal growth and well-being. After delivery, blinded placental injection studies delineated vascular anastomoses and territory share. Degree of balance in arteriovenous anastomoses equaled the number of arteriovenous anastomoses in one direction minus the number in the other.

RESULTS:
Pregnancies affected by fetofetal transfusion syndrome (n = 21) had numbers of arteriovenous and venovenous anastomoses that were similar to those in pregnancies without fetofetal transfusion syndrome but fewer arterioarterial anastomoses (P < .0001). Fetofetal transfusion syndrome occurred in 78% of pregnancies with ≥1 arteriovenous and no arterioarterial anastomoses. Birth weight discordancy correlated with placental territory discordancy (P < .0001) and the degree of balance in arteriovenous anastomoses (P = .004). The larger placental share twin had a greater growth velocity than its smaller placental share cotwin (P = .008) for all but one anastomotic pattern. Where arteriovenous anastomoses were aligned with the net venous outflow to the fetus with the smaller territory, co-twins had similar birth weights and growth velocities irrespective of placental share. Fetal survival was higher in pregnancies with an arterioarterial anastomosis (P = .01) but lower with a venovenous anastomosis (P = .01). Survival of both fetuses was inversely associated with birth weight discordancy (P < .0001).

CONCLUSION:
Although interrelationships among the various types of anastomoses are complex, our data suggest that the placental territory share and the pattern of arteriovenous anastomoses influence fetal growth, that arterioarterial anastomoses protect against fetofetal transfusion syndrome, and that venovenous anastomoses reduce perinatal survival.
Keyword Monochorionic twinning
Placental anastomoses
Twin-twin transfusion
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Faculty of Health and Behavioural Sciences -- Publications
 
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