Comparison of placental characteristics of twin-twin transfusion syndrome with and without selective intrauterine growth restriction

Wang, Xueju; Li, Luyao; Yuan, Pengbo; Zhao, Yangyu; Yuan, Wei

doi:10.1080/14767058.2020.1849110

Cited by 10 publications

(19 citation statements)

References 11 publications

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“…All complete monochorionic twin placentas were injected with the dye to examine placental superficial anastomoses, placental territory and umbilical cord insertion of the twins (Figure 1). Digital images were stored for the following data analysis 15 . The diameter of artery‐to‐artery (AA) and vein–vein anastomoses was measured in the smallest part, and the diameter of the artery–vein anastomoses on the arterial side 7,15 .…”

Section: Methodsmentioning

confidence: 99%

“…The types, number and diameter of placental anastomoses were all recorded. The umbilical cord insertion distance was defined as the distance between the centers of two umbilical cord insertion sites 15,16 . The placental maximum diameter was the largest range of placental parenchyma edge 15,16 .…”

Section: Methodsmentioning

confidence: 99%

“…15 The diameter of artery-to-artery (AA) and vein-vein anastomoses was measured in the smallest part, and the diameter of the artery-vein anastomoses on the arterial side. 7,15 Vascular anastomosis with a diameter ≥2 mm was defined as thick vascular anastomosis. 9,15 The types, number and diameter of placental anastomoses were all recorded.…”

Section: Placental Dye Injectionmentioning

confidence: 99%

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Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

Wang

Yuan

et al. 2021

Acta Obstet Gynecol Scand

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Introduction This study aimed to explore the differences in placental characteristics among three types of selective fetal growth restriction (sFGR) in monochorionic diamniotic twin pregnancies. Material and methods A total of 123 placentas with sFGR between April 2013 and October 2019 were retrospectively analyzed after dye injection. Placental characteristics were compared among the three types. Results The gestational age at diagnosis and delivery was less in sFGR II and III than in sFGR I (22.9 [21.7–33.6], 23.3 [20.0–26.1] and 25.7 [19.0–35.0] weeks, p < 0.001; 32.3 [31.6–35.1], 34.1 [29.9–34.7] and 35.5 [34.0–37.0] weeks, p < 0.001). The birthweight discordance ratio was less in sFGR I than in sFGR II (0.28 [0.14–0.43] and 0.30 [0.23–0.37], p < 0.001). The prevalence of a thick artery–artery anastomosis was higher in sFGR III than in sFGR I or II (81.8%, 44.9% and 48.6%, p = 0.010). The placental territory discordance ratio was higher in sFGR II and III than in sFGR I (0.60 [0.17–0.88], 0.60 [0.01–0.80] and 0.50 [0.01–0.71], p = 0.001). Conclusions Compared with sFGR I, the earlier onset time of sFGR II and III might be due to their higher placental territory discordance. The prevalence of thick artery–artery anastomoses was expected to be higher in sFGR III than in sFGR I or II.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Placental Dye Injectionmentioning

confidence: 99%

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Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

Wang

Yuan

et al. 2021

Acta Obstet Gynecol Scand

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“…Placental dye injection was conducted as per a protocol previously published by our institution. 13,14 A high-resolution digital image of a placenta following dye injection is shown in Figure 1.…”

Section: Methodsmentioning

confidence: 99%

“…Distances between umbilical cord insertion points were measured from the center of each insertion point. In cases of velamentous umbilical cords, the insertion point center was defined as the margin of the adjacent placental parenchyma 13,14 . The umbilical insertion ratio was defined as follows: the distance between two insertion points/the maximum placental diameter.…”

Section: Methodsmentioning

confidence: 99%

The relationship between placental characteristics and birthweight discordance in different types of selective intrauterine growth restriction in monochorionic diamniotic twins: A single‐center 7 year cohort study

Wang

Shi

et al. 2021

Prenatal Diagnosis

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Objective: To clarify the relationships between placental characteristics and birthweight discordance in three types of selective intrauterine growth restriction (sIUGR) in monochorionic diamniotic twins. Methods: A retrospective cohort study was conducted between april 2013 and april 2020. Associations between placental characteristics and birthweight discordance were evaluated through multiple linear regression analyses with two models for each sIUGR type. Model A was adjusted for gestational age, Model B additionally adjusted for the impact of placental characteristics interacted. Results: In cases of type I sIUGR, birthweight discordance ratio was positively associated with placental territory discordance ratio [(β = 0.181,95%CI (0.072,0.290), p < 0.05), (β = 0.239,95%CI(0.125, 0.353), p < 0.05)] under both Model A and Model B. In-type II sIUGR [(β = −0.012,95%CI(-0.020, −0.004), p < 0.05) (β = −0.010,95%CI (−0.018, −0.002), p < 0.05)] and type III sIUGR [(β = −0.011,95%CI (−0.021, −0.001), p < 0.05), (β = −0.012,95%CI(-0.022, −0.003), p < 0.05)], birthweight discordance ratio was negatively associated with the total diameter of all the anastomoses as calculated with both Model A and Model B. Conclusion: Birthweight discordance is primarily related to placental territory discordance in type I sIUGR, whereas vascular anastomoses play important roles for growth-restricted fetal compensation in type II and III sIUGR. Key points What's already known about this topic? � Placental characteristics associate with the onset of selective intrauterine growth restriction What does this study add? � Birthweight discordance is primarily related to placental territory discordance in type I sIUGR, whereas vascular anastomoses play important roles for growth-restricted fetal compensation in type II and III sIUGR 1518 -Prenatal Diagnosis.

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Correction of fetal umbilical vein flow imbalance following laser surgery for twin–twin transfusion syndrome

Saab

DeVore

Monson

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives Twin–twin transfusion syndrome (TTTS) is characterized by unequal hemodynamics between the twins. We aimed to assess preoperatively the difference in umbilical vein flow (UVF) between the recipient and donor monochorionic diamniotic twins and evaluate the change in UVF following laser surgery in both twins. Methods This was a retrospective cohort study of differences in UVF that occurred following laser surgical treatment of TTTS. Sonographic assessment of the umbilical vein before and 24 h after fetoscopic laser surgery for TTTS was performed. Umbilical vein diameter and time‐averaged maximum velocity were measured, and UVF per kg (UVF/kg) was converted into a Z‐score by a calculator created using gestational age as an independent variable. Z‐score values were converted into centiles, which were evaluated statistically. Median differences in UVF/kg centile values were adjusted for TTTS stage and presence of arterioarterial anastomoses. Results The study population consisted of 363 TTTS patients. The adjusted preoperative median difference in UVF/kg centile between the recipient vs donor twin was 17.9% (−17.1% to 57.6%), P < 0.0001. The adjusted median difference in UVF/kg centile between the postoperative vs preoperative period among recipients was 2.2% (−10.8% to 13.8%), P < 0.0001, while the adjusted median difference among donors was 27.3% (8.2%–34.6%), P < 0.0001. Conclusion The preoperative difference in UVF between the recipient and donor twins confirms the pathophysiology of TTTS. Postoperatively, the substantial increase in UVF of the donor twin and the relatively small increase in UVF of the recipient twin confirm that ablation of the vascular communications resulted in rapid improvement in perfusion of the donor twin. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Comparison of placental characteristics of twin-twin transfusion syndrome with and without selective intrauterine growth restriction

Cited by 10 publications

References 11 publications

Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

The relationship between placental characteristics and birthweight discordance in different types of selective intrauterine growth restriction in monochorionic diamniotic twins: A single‐center 7 year cohort study

Correction of fetal umbilical vein flow imbalance following laser surgery for twin–twin transfusion syndrome

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