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Velamentous cord insertion in monochorionic twin gestation. An added risk factor
1Department of Genetics, Permanente Medical Group, Oakland, California 94611-5693, USA. Geoffrey.Machin@ncal.kaiperm.org
The Journal of Reproductive Medicine
|January 23, 1998
Summary
Velamentous (VEL) cord insertions in monochorionic (MC) twins indicate higher risks for growth discordance and perinatal demise. Ultrasound can identify these high-risk VEL insertions for early intervention.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Placental Pathology
Background:
- Monochorionic (MC) twins share a placenta, leading to unique vascular connections.
- Umbilical cord insertion patterns can influence placental sharing and fetal outcomes.
- Identifying risk factors in MC twins is crucial for improving perinatal care.
Purpose of the Study:
- To investigate the impact of different umbilical cord insertion combinations on MC twin outcomes.
- To correlate cord insertion patterns with growth discordance, placental sharing, and perinatal mortality.
Main Methods:
- Analysis of 60 consecutive MC placentas.
- Classification of cord insertions as central/eccentric (CEN) or velamentous/marginal (VEL).
- Evaluation of growth discordance, placental sharing, vascular anastomoses, perinatal mortality, and fetofetal transfusion.
Main Results:
- Velamentous (VEL) insertions were observed in 45% of MC twins.
- The central/eccentric (CEN)/VEL combination occurred in 53% of pairs.
- The CEN/VEL group exhibited significantly higher rates of growth discordance (>20%), unequal placental sharing, uncompensated anastomoses, and perinatal demise.
Conclusions:
- Velamentous (VEL) cord insertion and the CEN/VEL combination identify high-risk subgroups in MC twins.
- Prenatal diagnosis of VEL cord insertions via ultrasound can aid in identifying at-risk pregnancies.
- This facilitates timely monitoring and management strategies for improved perinatal outcomes in MC twins.