The Placenta of Multiple Pregnancy

Strauß, Franz Josef; Benirschke, Kurt; Driscoll, Shirley G.

doi:10.1007/978-1-4612-9809-0_6

Cited by 8 publications

(11 citation statements)

References 168 publications

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“…Clinical information and sonography indicated in each case that the plethoric twin had died fi rst; the anemic recipient died later (in one case from listeriosis). Autopsy con fi rmed the transfusion syndrome from the marked discordance of the cardiac sizes (Benirschke 1992(Benirschke , 1993Benirschke and Masliah 2001 ) . Indeed, it is our opinion that discordance of the relative cardiac size is the most important means for the diagnosis of the transfusion syndrome; it can even be recognized sonographically in dead twins.…”

Section: Twin-to-twin Transfusion Syndromementioning

confidence: 98%

“…Added to that, since many such twins are markedly premature, their probability of developing periventricular leukomalacia is enhanced anyway. Moreover, when the placentas are examined in recent twin deaths, the pallor of that fetus' region that was once the recipient (and plethora of the donor's) territory is impressive (see Benirschke and Masliah 2001 ) . It is of course of concern that such events take place despite the generally superior success of laser ablation of TTTS.…”

Section: Fetus Papyraceusmentioning

confidence: 98%

“…Likewise, in the searching review of placental lesions with abnormal growth in twins, Redline et al ( 2001 ) found that peripheral cord insertion and, less signi fi cantly so, avascular villi and evidence of reduced maternal perfusion to be associated. Further, Benirschke and Masliah ( 2001 ) have reviewed the issue of discordant placental development in DiMo and DiDi placentas and considered the "competition for space" as one possible reason for the differences occurring in the placental development of multiples conceived by ART. Abnormal cord insertions are of concern to the perinatologist because of the possibly greater frequency of vasa previa in twins.…”

Section: Vascular Anatomy Of Twin Placentasmentioning

confidence: 99%

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Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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Section: Twin-to-twin Transfusion Syndromementioning

confidence: 98%

Section: Fetus Papyraceusmentioning

confidence: 98%

Section: Vascular Anatomy Of Twin Placentasmentioning

confidence: 99%

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Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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“…(1,3,38,39) Gestational hypertension is also very common, with overall prevalence in twin gestations reported at 9%-20%. (1,3,38,39) Moreover, there is a high risk of antepartum haemorrhage in twin gestations due to the higher incidence of placenta praevia, (40) with an approximately threefold increase in the frequency of abruption. (41) The reported incidence of antepartum haemorrhage in mothers carrying twins is 0.3%-0.7%.…”

Section: Discussionmentioning

confidence: 99%

Reappraisal of twinning: epidemiology and outcome in the early neonatal period

Gupta¹

2014

Singapore Med J

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INTRODUCTIONThe present study aimed to determine the epidemiology, maternal complications and adverse neonatal outcomes associated with twin births at a tertiary care hospital in India.METHODS A prospective observational study was conducted on all successively born twin pairs (≥ 23 weeks of gestation) and their mothers from January to September 2005. Main outcome measures included maternal medical/obstetric complications, labour characteristics and the morbidities/mortality observed during the early neonatal period. RESULTSThe twinning rate was 1 in 54 deliveries. Around 10% of mothers had a predisposition for twinning in the form of familial tendency or consumption of clomiphene. Anaemia (85%) was the most common maternal complication, followed by gestational hypertension (17%). Nearly one-third of births were delivered via Caesarean section. Prematurity (61%) was the most common neonatal complication followed by early-onset neonatal sepsis (21%). The risk of early neonatal death was 27%. Shorter gestation and low birth weight were significantly associated with adverse neonatal outcome (p < 0.05). Factors such as chorionicity, mode of delivery, birth order, inter-twin delivery time interval, gender and intra-pair birth weight discordance did not affect neonatal morbidity or mortality (p ≥ 0.05). CONCLUSIONThe rates of maternal complications and early neonatal morbidities/mortality were quite high in twin gestations. Except for the prematurity and low birth weight, none of the other factors, including inter-twin delivery time interval of more than 15 mins, were found to affect neonatal outcome.

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“…These exceptions include bilobed placentas and dichorionic monozygotic twins (Benirschke & Masliah, 2001;Chmait, Floyd et al, 2011;Machin, 2001). In cases of bilobed placentas, vascular anastomoses between the two discs allow the development of the syndrome (Lopriore et al, 2006).…”

Section: Single Placentamentioning

confidence: 99%

Twin-to-Twin Transfusion Syndrome: Definition, Staging, and Ultrasound Assessment

2016

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Objective: The purpose of this article is to review the definition of twin-to-twin transfusion syndrome (TTTS) and the sonographic diagnostic assessment of these cases prior to therapy. Materials and Methods: The article addresses the terminology used to refer to the condition and describes the systematic ultrasound assessment of the condition, including the ultrasound diagnosis, the staging of the disease, cervical assessment and pre-operative mapping. Results: From an etymologic and medical point of view, the term 'fetofetal transfusion' is more appropriate than 'TTTS'. However, as the latter, and its attendant acronym TTTS, have been widely adopted in the English language, it is impractical to change at this point. TTTS is defined sonographically in the combined presence of a maximum vertical pocket (MVP) of 8 cm or greater in one sac and 2 cm or less in the other sac, regardless of the gestational age at diagnosis. Staging of the condition using the Quintero staging system is practical, reproducible, and accepted. Transvaginal cervical length assessment should be an integral part of the ultrasound evaluation. Pre-operative mapping to anticipate the location of the placental vascular anastomoses and avoid injuring the dividing membrane is also discussed. Conclusions: The term 'TTTS' can continue to be used in the English medical literature. The condition can be diagnosed and assessed following a systematic ultrasound methodology. The use of such ultrasound methodology breaks the examination into a distinct set of components, assuring a comprehensive examination and proper communication among caregivers.

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The Placenta of Multiple Pregnancy

Cited by 8 publications

References 168 publications

Multiple Pregnancies

Multiple Pregnancies

Reappraisal of twinning: epidemiology and outcome in the early neonatal period

Twin-to-Twin Transfusion Syndrome: Definition, Staging, and Ultrasound Assessment

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