Placenta
Volume 31, Issue 4 , Pages 269-276 , April 2010

Placental markers of twin-to-twin transfusion syndrome in diamniotic–monochorionic twins: A morphometric analysis of deep artery-to-vein anastomoses

  • M.E. De Paepe

      Affiliations

    • Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
    • Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI, USA
    • Corresponding Author InformationCorresponding author. Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA. Tel.: +1 401 274 1122x1544; fax: +1 401 453 7681.
  • ,
  • S. Shapiro

      Affiliations

    • Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
  • ,
  • D. Greco

      Affiliations

    • Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
  • ,
  • V.L. Luks

      Affiliations

    • Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
  • ,
  • R.G. Abellar

      Affiliations

    • Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
    • Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI, USA
  • ,
  • C.H. Luks

      Affiliations

    • Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
  • ,
  • F.I. Luks

      Affiliations

    • Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, RI, USA

,Accepted 22 December 2009.

References 

  1. Lewi L, Van Schoubroeck D, Gratacos E, Witters I, Timmerman D, Deprest J. Monochorionic diamniotic twins: complications and management options. Curr Opin Obstet Gynecol. 2003;15:177–194
  2. Ortibus E, Lopriore E, Deprest J, Vandenbussche FP, Walther FJ, Diemert A, et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol. 2009;200(494):e491–e498
  3. Huber A, Hecher K. How can we diagnose and manage twin–twin transfusion syndrome?. Best Pract Res Clin Obstet Gynaecol. 2004;18:543–556
  4. Urig MA, Clewell WH, Elliott JP. Twin–twin transfusion syndrome. Am J Obstet Gynecol. 1990;163:1522–1526
  5. De Lia JE, Cruikshank DP, Keye WR. Fetoscopic neodymium:YAG laser occlusion of placental vessels in severe twin–twin transfusion syndrome. Obstet Gynecol. 1990;75:1046–1053
  6. Bajoria R, Wigglesworth J, Fisk NM. Angioarchitecture of monochorionic placentas in relation to the twin–twin transfusion syndrome. Am J Obstet Gynecol. 1995;172:856–863
  7. Denbow ML, Cox P, Talbert D, Fisk NM. Colour Doppler energy insonation of placental vasculature in monochorionic twins: absent arterio-arterial anastomoses in association with twin-to-twin transfusion syndrome. Br J Obstet Gynaecol. 1998;105:760–765
  8. Fries MH, Goldstein RB, Kilpatrick SJ, Golbus MS, Callen PW, Filly RA. The role of velamentous cord insertion in the etiology of twin–twin transfusion syndrome. Obstet Gynecol. 1993;81:569–574
  9. Gaziano EP, De Lia JE, Kuhlmann RS. Diamnionic monochorionic twin gestations: an overview. J Matern Fetal Med. 2000;9:89–96
  10. Machin GA. Velamentous cord insertion in monochorionic twin gestation. An added risk factor. J Reprod Med. 1997;42:785–789
  11. Denbow ML, Cox P, Taylor M, Hammal DM, Fisk NM. Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol. 2000;182:417–426
  12. Bermudez C, Becerra CH, Bornick PW, Allen MH, Arroyo J, Quintero RA. Placental types and twin–twin transfusion syndrome. Am J Obstet Gynecol. 2002;187:489–494
  13. Benirschke K, Kaufmann P. Pathology of the human placenta. New York: Springer-Verlag; 2000;
  14. Bajoria R. Vascular anatomy of monochorionic placenta in relation to discordant growth and amniotic fluid volume. Hum Reprod. 1998;13:2933–2940
  15. Machin G, Still K, Lalani T. Correlations of placental vascular anatomy and clinical outcomes in 69 monochorionic twin pregnancies. Am J Med Genet. 1996;61:229–236
  16. De Paepe ME, Burke S, Luks FI, Pinar H, Singer DB. Demonstration of placental vascular anatomy in monochorionic twin gestations. Pediatr Dev Pathol. 2002;5:37–44
  17. Robertson EG, Neer KJ. Placental injection studies in twin gestation. Am J Obstet Gynecol. 1983;147:170–174
  18. van Gemert MJ, Sterenborg HJ. Haemodynamic model of twin–twin transfusion syndrome in monochorionic twin pregnancies. Placenta. 1998;19:195–208
  19. Umur A, van Gemert MJ, Nikkels PG, Ross MG. Monochorionic twins and twin–twin transfusion syndrome: the protective role of arterio-arterial anastomoses. Placenta. 2002;23:201–209
  20. Taylor MJ, Denbow ML, Duncan KR, Overton TG, Fisk NM. Antenatal factors at diagnosis that predict outcome in twin–twin transfusion syndrome. Am J Obstet Gynecol. 2000;183:1023–1028
  21. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin–twin transfusion syndrome. J Perinatol. 1999;19:550–555
  22. Pinar H, Sung CJ, Oyer CE, Singer DB. Reference values for singleton and twin placental weights. Pediatr Pathol Lab Med. 1996;16:901–907
  23. De Paepe ME, DeKoninck P, Friedman RM. Vascular distribution patterns in monochorionic twin placentas. Placenta. 2005;26:471–475
  24. De Paepe ME, Friedman RM, Poch M, Hansen K, Carr SR, Luks FI. Placental findings after laser ablation of communicating vessels in twin-to-twin transfusion syndrome (TTTS). Pediatr Dev Pathol. 2004;7:159–165
  25. Saunders NJ, Snijders RJ, Nicolaides KH. Therapeutic amniocentesis in twin–twin transfusion syndrome appearing in the second trimester of pregnancy. Am J Obstet Gynecol. 1992;166:820–824
  26. Bruner JP, Anderson TL, Rosemond RL. Placental pathophysiology of the twin oligohydramnios–polyhydramnios sequence and the twin–twin transfusion syndrome. Placenta. 1998;19:81–86
  27. Lopriore E, Sueters M, Middeldorp JM, Oepkes D, Walther FJ, Vandenbussche FP. Velamentous cord insertion and unequal placental territories in monochorionic twins with and without twin-to-twin-transfusion syndrome. Am J Obstet Gynecol. 2007;196(159):e151–e155
  28. Diehl W, Hecher K, Zikulnig L, Vetter M, Hackeloer BJ. Placental vascular anastomoses visualized during fetoscopic laser surgery in severe mid-trimester twin–twin transfusion syndrome. Placenta. 2001;22:876–881
  29. Machin GA, Feldstein VA, van Gemert MJ, Keith LG, Hecher K. Doppler sonographic demonstration of arterio-venous anastomosis in monochorionic twin gestation. Ultrasound Obstet Gynecol. 2000;16:214–217
  30. Bajoria R, Ward S, Chatterjee R. Brain natriuretic peptide and endothelin-1 in the pathogenesis of polyhydramnios–oligohydramnios in monochorionic twins. Am J Obstet Gynecol. 2003;189:189–194
  31. Galea P, Barigye O, Wee L, Jain V, Sullivan M, Fisk NM. The placenta contributes to activation of the renin angiotensin system in twin–twin transfusion syndrome. Placenta. 2008;29:734–742
  32. Mahieu-Caputo D, Meulemans A, Martinovic J, Gubler MC, Delezoide AL, Muller F, et al. Paradoxic activation of the renin-angiotensin system in twin–twin transfusion syndrome: an explanation for cardiovascular disturbances in the recipient. Pediatr Res. 2005;58:685–688
  33. Lewi L, Jani J, Cannie M, Robyr R, Ville Y, Hecher K, et al. Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye?. Am J Obstet Gynecol. 2006;194:790–795
  34. van den Wijngaard JP, Lopriore E, van der Salm SM, Schaap AH, Vandenbussche FP, Deruiter MC, et al. Deep-hidden anastomoses in monochorionic twin placentae are harmless. Prenat Diagn. 2007;27:233–239
  35. Kusanovic JP, Romero R, Espinoza J, Nien JK, Kim CJ, Mittal P, et al. Twin-to-twin transfusion syndrome: an antiangiogenic state?. Am J Obstet Gynecol. 2008;198(382):e381–e388

PII: S0143-4004(09)00414-7

doi: 10.1016/j.placenta.2009.12.024

Placenta
Volume 31, Issue 4 , Pages 269-276 , April 2010