Title: Angioarchitecture of monochorionic placentas in relation to the twin-twin transfusion syndrome
Abstract: Twin-twin transfusion syndrome in the midtrimester is associated with a perinatal mortality rate exceeding 80%. Although attributed to intertwin transfusion along vascular anastomoses, these occur in all monochorial placentas, not just the 10% with twin-twin transfusion syndrome. We compared fetoplacental angioarchitecture in monochorionic twin placentas with and without twin-twin transfusion syndrome.The fetoplacental circulations of both twins in 20 monochorial placentas were perfused immediately after delivery under optimal physiologic conditions and anastomoses delineated by dye-contrast injection. Ten were from pregnancies with evidence of midtrimester twin-twin transfusion syndrome and 10 were from pregnancies without twin-twin transfusion syndrome.Placentas from pregnancies with twin-twin transfusion syndrome had significantly fewer anastomoses than did those without twin-twin transfusion syndrome, both overall (median one versus six, respectively; p < 0.001) and for each of the different types (arterioarterial, venovenous, and arteriovenous, p < 0.001). Whereas multiple anastomoses were present in all controls, only one twin-twin transfusion syndrome placenta had more than a single communication. Anastomoses in the twin-twin transfusion syndrome group were more likely to be of the deep than the superficial type (80% vs 36% in controls, p < 0.01).Placental vascular anastomoses in monochorial pregnancies complicated by twin-twin transfusion syndrome are both fewer in number and of a different type than those without twin-twin transfusion syndrome. These differences seem implicated in the underlying pathophysiologic features of twin-twin transfusion syndrome and are of relevance to the development of newer therapies such as placental laser surgery.
Publication Year: 1995
Publication Date: 1995-03-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 285
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