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

Denbow, Mark; Cox, Phillip; Taylor, M. J. O.; Hammal, Donna; Fisk, Nicholas M.

doi:10.1016/s0002-9378(00)70233-x

Cited by 419 publications

(321 citation statements)

References 19 publications

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“…The clinical implications of the presence of artererio-arterial anastomoses in monochorionic placentas is that they have been found to protect against the development of twin-twin transfusion syndrome [2,3] in fetuses. In the few cases which develop twin-twin transfusion syndrome the fetuses with an arterio-arterial anastomosis present have a higher survival rate [15].…”

Section: Resultsmentioning

confidence: 99%

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Time domain computational modelling of 1D arterial networks in monochorionic placentas

Franke¹,

Parker

Wee

et al. 2003

ESAIM: M2AN

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Abstract. In this paper we outline the hyperbolic system of governing equations describing onedimensional blood flow in arterial networks. This system is numerically discretised using a discontinuous Galerkin formulation with a spectral/hp element spatial approximation. We apply the numerical model to arterial networks in the placenta. Starting with a single placenta we investigate the velocity waveform in the umbilical artery and its relationship with the distal bifurcation geometry and the terminal resistance. We then present results for the waveform patterns and the volume fluxes throughout a simplified model of the arterial placental network in a monochorionic twin pregnancy with an arterio-arterial anastomosis and an arterio-venous anastomosis. The effects of varying the time period of the two fetus' heart beats, increasing the input flux of one fetus and the role of terminal resistance in the network are investigated and discussed. The results show that the main features of the in vivo, physiological waves are captured by the computational model and demonstrate the applicability of the methods to the simulation of flows in arterial networks.Mathematics Subject Classification. 92C35, 76Z05.

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Section: Resultsmentioning

confidence: 99%

“…Typically the heart rates of the fetuses are different, which will produce a wave pattern which is repeated periodically with a frequency dependent on the difference in heart rates [17]. Venous-venous anastomoses are rare and maybe associated with a lower survival [3].…”

Section: Monochorionic Placentasmentioning

confidence: 99%

Time domain computational modelling of 1D arterial networks in monochorionic placentas

Franke¹,

Parker

Wee

et al. 2003

ESAIM: M2AN

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“…It is now well established that increased mortality and morbidity of the survivors are related to acute exsanguinations into the dead fetus and its placenta at around the time of death. [6][7][8][9] Denbow et al 10 and Taylor et al 11 have demonstrated that the outcome of MC pregnancies as well as When the diagnosis of single IUD is made in an MC pregnancy, one should seek ultrasound and Doppler features of fetal anaemia. 10 Acute and profound anaemia can cause death or ischemia of several organs such as brain, liver, bowel, kidneys and limbs related to low blood flow.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] Denbow et al 10 and Taylor et al 11 have demonstrated that the outcome of MC pregnancies as well as When the diagnosis of single IUD is made in an MC pregnancy, one should seek ultrasound and Doppler features of fetal anaemia. 10 Acute and profound anaemia can cause death or ischemia of several organs such as brain, liver, bowel, kidneys and limbs related to low blood flow. 3 This led us to include counselling on the possibility of invasive testing and intrauterine fetal blood transfusion in an attempt to prevent mortality, and potentially prevent the development of several injuries related to the persistence and severity of vascular imbalance and severe anaemia.…”

Section: Introductionmentioning

confidence: 99%

Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto‐fetal transfusion syndrome

Quarello

Stirnemann

Nassar

et al. 2008

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Objective To evaluate the outcome of severely anaemic monochorionic (MC) twins surviving the death of their co-twin following early intrauterine rescue transfusion in cases of feto-fetal transfusion syndrome (FFTS).Study design We reviewed all MC pregnancies complicated with FFTS following primary management, in which a single intrauterine fetal death (IUFD) was diagnosed with certainty within 24 hours between January 1999 and December 2006. We included MC survivors who presented ultrasound or Doppler features of fetal anaemia following the death of their co-twin. Intrauterine transfusion (IUT) was given to all survivors who were anaemic.Results Nineteen MC twin pregnancies presented a single intrauterine death (IUD) associated with an anaemic co-twin. Median gestational age at IUD was 23 [20][21][22][23][24][25][26][27][28] weeks. The median interval between IUD and IUT was 12 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] hours. There were 58% (11/19) healthy survivors. Perinatal death rate was 26% (5/19) including 16% (3/19) intrauterine and 10% (2/19) neonatal deaths. Abnormal prenatal cerebral findings developed in 21% (4/19) cases, always within 1 month after the death of the co-twin. Considering occlusive techniques and other management separately, there were 64% (7/11) and 50% (4/8) healthy survivors, respectively, and perinatal death occurred in 36% (4/11) and 12.5% (1/8) of fetuses, respectively. Prenatal fetal cerebral lesions developed in 9% (1/11) of cases following occlusive techniques and in 37.5% (3/8) of fetuses when managed differently. The median gestational age at delivery in the survivors was 31 [25][26][27][28][29][30][31][32][33][34][35][36][37][38] weeks. ConclusionIn cases of FFTS with single anaemic survivors, early IUT could be offered following extensive counselling and close follow up.

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“…2,3 Placental vascular anastomoses provide the basis for intertwin transfusion ("donor" to "recipient") and failure to compensate for the circulatory imbalance set up by deep unidirectional arteriovenous anastomoses, as the result of a paucity of superficial bidirectional arterioarterial anastomoses, has been proposed as the pathogenic mechanism. 4,5 Both donor and recipient twins have dynamic changes in volume loading during cardiovascular development constituting a hostile intrauterine environment. The hypervolemic recipient fetus has polyuria and polyhydramnios and hypertrophic cardiomyopathy and hydrops may develop.…”

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confidence: 99%

Twin-Twin Transfusion Syndrome

et al. 2003

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Background-In twin-twin transfusion syndrome (TTTS), the donor and recipient fetus are exposed to differing volume loads and show discordant intertwin vascular compliance in childhood despite identical genotype. We hypothesized that discordance is prevented by intrauterine endoscopic laser ablation of placental anastomoses, which abolishes intertwin transfusion. We tested this by examining pulse wave velocity (PWV) in brachial arteries of twin survivors of TTTS treated with and without laser therapy. Methods and Results-One hundred children (50 twin pairs, 27 with TTTS) were studied. Group 1 comprised 14 monochorionic (MC) twin pairs with TTTS treated symptomatically; group 2 comprised 13 MC twin pairs with TTTS treated by laser. The control groups comprised 12 MC twin pairs without TTTS (group 3) and 11 dichorionic twin pairs (group 4). Fetal cardiovascular data, predictive factors for, and duration of TTTS and cord blood were collected prospectively. We measured blood pressure and PWV photoplethysmographically at a median corrected postnatal age of 11 months (range, 1 week to 66 months). Both TTTS groups showed marked intertwin PWV discordance, unlike MCDA control subjects. The PWV discordance seen in laser treated twin pairs resembled that of dichorionic control subjects (heavier individual with higher PWV), whereas group 1 showed the opposite (negative) intertwin discordance (ANOVA F (1,45)ϭ4.5, Pϭ0.04). No significant differences in blood pressure or intrauterine growth were observed between TTTS groups. Conclusions-Vascular programming is evident in monozygotic twins with intertwin transfusion and is altered but not abolished by intrauterine therapy to resemble that seen in dichorionic twins.

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

Cited by 419 publications

References 19 publications

Time domain computational modelling of 1D arterial networks in monochorionic placentas

Time domain computational modelling of 1D arterial networks in monochorionic placentas

Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto‐fetal transfusion syndrome

Twin-Twin Transfusion Syndrome

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