Significance of Velamentous Cord Insertion for Twin-Twin Transfusion Syndrome

Abstract

Introduction: The objective of this study was to evaluate the actual association between velamentous cord insertion (VCI) and twin-twin transfusion syndrome (TTTS) in the native cohort concerning the natural history of monochorionic twin pregnancies. Material and Methods: All monochorionic diamniotic twin pregnancies who received prenatal care from <16 weeks of gestation until delivery at our center between 2004 and 2013 were included in this retrospective cohort study. Macroscopically defined cord insertion site was recorded as velamentous, marginal, or central. The effects of VCI on TTTS and a composite of adverse outcomes, including abortion, death, and neurological morbidities ≤28 days of age, were evaluated with a multiple logistic regression model. Results: A total of 357 monochorionic diamniotic twin pregnancies were analyzed. VCI in both twins was noted in 2.5% of cases and VCI in at least one twin was noted in 22.1% of cases. The incidence of TTTS was 8.4%; the incidence of a composite of adverse outcomes in at least one twin was 9.8%. There was no correlation between VCI and TTTS as well as a composite of adverse outcomes. Discussion: VCI in monochorionic twin pregnancies was not a risk factor for TTTS and severe perinatal morbidities.

Prevalence of Extraplacental Anastomoses in Monochorionic Twin Pregnancies

“…The association between VCI of both twins and the presence of EPA was described for the first time in our study. According to our results, the prevalence of VCI in at least 1 cord and of VCI in both cords was 23% (33/144) and 4.2% (6/144), respectively, which was comparable to the findings of a previous report from our center [10]. In the case of an MCDA twin with VCI of both fetuses, both chorionic vessels were composed of the EPA that originated outside the placental parenchyma; thereafter, the complete vessels were located outside the placental parenchyma.…”

Significance of placental cord insertion site in twin pregnancy

“…The literature search yielded 118 citations. After exclusion of studies by reviewing the abstracts, 13 studies reporting on the association of cord insertion site with either sFGR, birth‐weight discordance or TTTS in MCDA twin pregnancies were retrieved,,,. Data from these studies were used to construct a review table (Table ).…”

“…The literature search yielded 118 citations. After exclusion of studies by reviewing the abstracts, 13 studies reporting on the association of cord insertion site with either sFGR, birth-weight discordance or TTTS in MCDA Table 4 Summary of studies on associations between abnormal cord insertion in monochorionic diamniotic twin pregnancy and birth-weight discordance, selective fetal growth restriction (FGR) and twin-to-twin transfusion syndrome (TTTS) twin pregnancies were retrieved 18,[20][21][22][23][24][28][29][30][37][38][39][40] . Data from these studies were used to construct a review table (Table 4).…”

“…This association is backed by a study by De Paepe et al ,. but most studies suggest a non‐significant association between velamentous cord insertion and the development of TTTS. A large multicenter study is required to address this question robustly.…”

Twin-Twin Transfusion Syndrome in Cases with Suspected Close Proximity of Umbilical Cord Insertions

“…The aim of FLP is to separate the anastomoses between the CIs of twins at the vascular equator, as in a dichorionic placenta. CIs are usually located in different places, and insertion can be velamentous [4], eccentric, or side by side. However, when the CIs of twins are in close proximity, laser ablation of the vascular anastomoses may be technically impossible.…”