The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence

Couck, Isabel; Lewi, Liesbeth

doi:10.1017/thg.2016.29

Cited by 32 publications

(21 citation statements)

References 41 publications

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“…FGR can be challenging to diagnose as placental function cannot currently be directly measured. Surrogate markers, such as abnormal fetal growth trajectory or abnormal blood flow to the placenta, are used with varying success. At present, there is no treatment for FGR, or the associated condition pre‐eclampsia; however, trials are exploring several new therapeutic avenues, including sildenafil, esomeprazole, metformin, pravastatin, and vascular endothelial growth factor maternal gene therapy .…”

Section: Introductionmentioning

confidence: 99%

Placental MRI and its application to fetal intervention

et al. 2019

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Objective Magnetic resonance imaging (MRI) of placental invasion has been part of clinical practice for many years. The possibility of being better able to assess placental vascularization and function using MRI has multiple potential applications. This review summarises up‐to‐date research on placental function using different MRI modalities. Method We discuss how combinations of these MRI techniques have much to contribute to fetal conditions amenable for therapy such as singletons at high risk for fetal growth restriction (FGR) and monochorionic twin pregnancies for planning surgery and counselling for selective growth restriction and transfusion conditions. Results The whole placenta can easily be visualized on MRI, with a clear boundary against the amniotic fluid, and a less clear placental‐uterine boundary. Contrasts such as diffusion weighted imaging, relaxometry, blood oxygenation level dependent MRI and flow and metabolite measurement by dynamic contrast enhanced MRI, arterial spin labeling, or spectroscopic techniques are contributing to our wider understanding of placental function. Conclusion The future of placental MRI is exciting, with the increasing availability of multiple contrasts and new models that will boost the capability of MRI to measure oxygen saturation and placental exchange, enabling examination of placental function in complicated pregnancies.

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Section: Introductionmentioning

confidence: 99%

Placental MRI and its application to fetal intervention

et al. 2019

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“…Rarely, A‐V connections may be absent in TOPS . V‐V anastomoses are the least frequent type of anastomoses seen in monochorionic placentas, but they are seen more commonly in TOPS than in uncomplicated monochorionic pregnancies , and it has been suggested that they may have a role in development of TOPS in some instances .…”

Section: Complications In Monochorionic Twinsmentioning

confidence: 99%

“…Although TOPS is a transfusional process (confirmed by the therapeutic success of separating the vascular connections), other factors, including humoral, are at play that mediate the complex clinical phenotype in these cases . It appears that the key feature in TOPS is one of volume imbalance which is in contrast to TAPS where hemoglobin differences are the principle effect of the transfusion .…”

Section: Complications In Monochorionic Twinsmentioning

confidence: 99%

Histopathological examination of the placenta in twin pregnancies

Fitzgerald

2018

APMIS

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Twin placentas are frequently received in pathology laboratories for evaluation of chorionicity and because twin pregnancies have higher rates of pregnancy complications. In addition to pathologies common in singleton pregnancies, twin pregnancies have increased frequencies of complications such as preterm birth and velamentous cord insertions and also are affected by complications unique to multiple pregnancies that are mediated by vascular connections between the placental territories of certain types of twins. This article aims to provide an approach to examination of the twin placenta for practicing pathologists or those interested in placental pathology while outlining the key characteristics of twin complications as seen in the placenta.

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“…Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects 1 in 40 multiple gestations 1. In monochorionic twin pregnancies, both fetuses share one placenta that possesses vascular anastomoses on the fetal surface that connect the blood circulation of both twins 2. Vascular anastomoses between the two placentae in dichorionic pregnancies, although rare, have been demonstrated 3.…”

Section: Introductionmentioning

confidence: 99%

Dichorionic pregnancy complicated by a twin-to-twin transfusion syndrome

et al. 2019

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Twin-to-twin transfusion syndrome (TTTS) is a serious complication typical of monochorionic pregnancies. Cases in dichorionic pregnancies have been described. The authors present a case report of a presumed TTTS in a dichorionic pregnancy followed at our institution in which the patient presented to the emergency department at 31 4/7 weeks’ gestation complaining of lack of fetal movements. Both fetuses did not show any cardiac activity. On the first twin, an oligohydramnios was present and his bladder was not visualised and, on the second twin, a polyhydramnios and an augmented bladder were visualised. Pathological findings of the fetuses were compatible with a diagnosis of TTTS and placental study confirmed the presence of a dichorionic/diamniotic placenta, with superficial vessels crossing the dividing membrane.

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The Placenta in Twin-to-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence

Cited by 32 publications

References 41 publications

Placental MRI and its application to fetal intervention

Placental MRI and its application to fetal intervention

Histopathological examination of the placenta in twin pregnancies

Dichorionic pregnancy complicated by a twin-to-twin transfusion syndrome

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