Hydrostatic and osmotic pressure gradients produce manifestations of fetofetal transfusion syndrome in a computerized model of monochorial twin pregnancy

Talbert, David G., Bajoria, Rekha, Sepulveda, Waldo, Bower, Sarah and Fisk, Nicholas M. (1996) Hydrostatic and osmotic pressure gradients produce manifestations of fetofetal transfusion syndrome in a computerized model of monochorial twin pregnancy. American Journal of Obstetrics and Gynecology, 174 2: 598-608. doi:10.1016/S0002-9378(96)70434-9


Author Talbert, David G.
Bajoria, Rekha
Sepulveda, Waldo
Bower, Sarah
Fisk, Nicholas M.
Title Hydrostatic and osmotic pressure gradients produce manifestations of fetofetal transfusion syndrome in a computerized model of monochorial twin pregnancy
Journal name American Journal of Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0002-9378
1097-6868
Publication date 1996-02
Sub-type Article (original research)
DOI 10.1016/S0002-9378(96)70434-9
Volume 174
Issue 2
Start page 598
End page 608
Total pages 11
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Formatted abstract
OBJECTIVE:
In spite of recent advances in the assessment and treatment of fetofetal transfusion syndrome, its underlying mechanism remains controversial. We aimed to determine whether the clinical features of fetofetal transfusion syndrome could be explained by unidirectional or bidirectional intertwin transfusion along placental vascular anastomoses.

STUDY DESIGN:

We constructed a dynamic computerized model of monochorial twin fetoplacental units on the basis of numerous interrelated hemodynamic, osmotic, and metabolic physiologic variables. The circulations were then linked by various combinations of direction and number of arteriovenous anastomoses.

RESULTS:

With unidirectional anastomoses disease severity, characterized by disparity in blood solids, depended on donor arterial pressure but not on the number of anastomoses. In the chronic state water movement resulting from raised osmotic pressure in the recipient and reduction in the donor produced hydroosmotic pressure equilibrium, reducing anastomotic flow to near zero. Atrial natriuretic peptide-driven urine production was markedly increased in the recipient because of the raised vascular hydrostatic pressure component. With bidirectional anastomoses recirculation between twins reduced discordancy in colloids and hematocrit, and the clinical picture was determined by the degree of asymmetry in the number of connections.

CONCLUSIONS:
Severe manifestations of fetofetal transfusion syndrome can be explained by unidirectional intertwin transfusion and lesser degrees by asymmetric bidirectional transfusion.
Keyword Fetofetal transfusion syndrome
Monochorionic multiple pregnancy
Placental vascular anastomoses
Laser
Computer modeling
Fetal physiology
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
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 58 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 64 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 24 Oct 2011, 17:53:30 EST by System User on behalf of Faculty Of Health Sciences