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The consequences of monochorionic placentation

M L Denbow1, N M Fisk

  • 1Centre for Fetal Care, Imperial College School of Medicine, Queen Charlotte's and Chelsea Hospital, London, UK.

Bailliere'S Clinical Obstetrics and Gynaecology
|February 4, 1999
PubMed
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Monochorionic (MC) placentation involves vascular connections between twins. Imbalances in blood flow can cause acute, chronic, or reverse intertwin transfusion, leading to severe complications for one or both fetuses.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatology
  • Fetal Medicine

Background:

  • Monochorionic (MC) placentation occurs in 66% of identical twins, involving shared placental vasculature.
  • Vascular anastomoses within MC placentas facilitate intertwin blood flow, which can become imbalanced.
  • Such imbalances lead to distinct clinical conditions: acute, chronic, or reverse intertwin transfusion.

Purpose of the Study:

  • To describe the pathophysiology and clinical manifestations of intertwin transfusion syndromes in monochorionic pregnancies.
  • To differentiate between acute, chronic (feto-fetal transfusion syndrome), and reverse (acardiac) intertwin transfusion.
  • To highlight the risks and sequelae associated with each type of transfusion imbalance.

Main Methods:

  • Review of existing literature on monochorionic placentation and intertwin transfusion.

Related Experiment Videos

  • Classification of intertwin transfusion based on timing and mechanism (acute, chronic, reverse).
  • Description of clinical sequelae for donor, recipient, and co-twin.

    • Main Results:

    • Acute transfusion: associated with demise or neurological damage in the surviving twin following the death of one MC twin.
    • Chronic transfusion (feto-fetal transfusion syndrome): gradual blood flow from donor to recipient twin, causing polyhydramnios and preterm labor risks.
    • Reverse transfusion (acardiac twinning): retrograde perfusion leading to a non-viable acardiac twin and a stressed 'pump' twin.

    Conclusions:

    • Intertwin transfusion in MC pregnancies presents with diverse and severe clinical outcomes.
    • Understanding the specific type of transfusion is crucial for predicting fetal prognosis and managing pregnancy complications.
    • Prompt recognition and management are essential to mitigate adverse outcomes in affected MC twins.