Monoamniotic-versus diamniotic-monochorionic twin placentas: anastomoses and twin-twin transfusion syndrome |
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Authors: | Umur Asli van Gemert Martin J C Nikkels Peter G J |
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Affiliation: | From the Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam,a and the Department of Pathology, University Medical Center, Utrech.b Netherlands |
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Abstract: | ObjectiveThe purpose of this study was to compare monoamniotic-monochorionic and diamniotic-monochorionic twin placentas and to estimate the incidence of twin-twin transfusion syndrome in monoamniotic-monochorionic twin pregnancies.Study designWe analyzed the angioarchitecture and cord insertion distance in 24 monoamniotic-monochorionic and 200 diamniotic-monochorionic placentas.ResultsCompared with diamniotic-monochorionic placentas, monoamniotic-monochorionic placentas had significantly more arterioarterial anastomoses (20/20 vs 159/200, respectively; P = .013), significantly less opposite arteriovenous anastomoses (10/20 vs 165/200, respectively; P = .002), similar venovenous anastomoses (6/20 vs 46/200, respectively; P = .323), and arteriovenous anastomoses (20/20 vs 187/200 respectively; P = .279) and significantly shorter umbilical cord distances (median [±SD], 5.0±6.9 cm vs 17.5±6.8 cm; P<.001).ConclusionMonoamniotic-monochorionic and diamniotic-monochorionic placentas have different anastomotic patterns. The (virtually) 100% incidence of arterioarterial anastomoses in monoamniotic-monochorionic placentas explains the reason that twin-twin transfusion syndrome rarely occurs in monoamniotic-monochorionic twin pregnancies and predicts that twin-twin transfusion syndrome manifestations are approximately 5 times less often recognized in monoamniotic-monochorionic pregnancies than in diamniotic-monochorionic pregnancies. |
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Keywords: | Monoamniotic monochorionic placentas anastomoses twin-twin transfusion syndrome umbilical cord distance |
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