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Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye
Published on: September 5, 2011
Monoamniotic-versus diamniotic-monochorionic twin placentas: anastomoses and twin-twin transfusion syndrome
Asli Umur1, Martin J C van Gemert, Peter G J Nikkels
1Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Objective:
The 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 Design:
We analyzed the angioarchitecture and cord insertion distance in 24 monoamniotic-monochorionic and 200 diamniotic-monochorionic placentas.
Results:
Compared 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).
Conclusion:
Monoamniotic-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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