scholarly journals Twin-to-twin transfusion syndrome: new macroscopic and microscopic findings

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Cátia Lopes ◽  
Inês Cunha ◽  
Catarina Camacho ◽  
Catarina Vareda ◽  
Ana Lai ◽  
...  
Keyword(s):  
Anthropometric Parameters ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
New Findings ◽  
Neurological Morbidity ◽  
Macroscopic Findings ◽  
Twin Pregnancies ◽  
Pulmonary Abnormalities ◽  
Microscopic Findings

Abstract Background Twin-to-twin Transfusion Syndrome (TTTS) is a serious complication of monochorionic twin pregnancies. Affects about 10% to 15% of pregnancies and it is associated with high fetal and neonatal mortality, as well as cardiac and neurological morbidity in surviving fetuses. The main objective was to characterize a series of fetuses with TTTS since the pathophysiology of the syndrome is not fully understood and the clinical spectrum is broad. Methods Post-mortem macroscopic and microscopic examination of 26 fetuses (from 2010 to 2020) with TTTS syndrome. Results The most frequent macroscopic findings in placenta were discrepancy in size and pallor/placental congestion. Other macroscopic findings not described in the literature were calcifications, areas of infarction and hematomas. Infarction areas and villi heterogeneity growth were the most common microscopic findings, described in the literature. Regarding the fetus, the restriction of intrauterine growth, the alteration of anthropometric parameters and the presence of a plethoric/anemic fetus were the main characteristics associated with this syndrome. The most common microscopic findings were signs of anoxia and congestive organs, already described in the literature. We also found frequently pulmonary abnormalities as new findings in our study. Conclusions The results allowed the identification of TTTS aspects that can contribute to the characterization of this syndrome. Given that the progression of TTTS remains unpredictable and the mortality rate for both fetuses is 90%, it becomes increasingly important to identify strategies for diagnosing and characterizing the syndrome.

scholarly journals Monochorionic twin pregnancies increases perinatal risk and is a high risk factor of selective intrauterine growth restriction

2019 ◽  
Author(s):  
Jie Chen ◽  
Yue Lian Yang
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Intrauterine Growth Restriction ◽  
Growth Restriction ◽  
Prenatal Health ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
High Risk Factor ◽  
Twin Pregnancies

Abstract Background Twins pregnancy can cause a lot of disease, especially monochorionic twin pregnancies, the prenatal infant will have many diseases and have high mortality rate. According to analysis and compare of the twin pregnancy, especially pregnant woman and puerpera’s situation and complication and baby’s situation; we hope we can find the reason which causes the fetus growth restrain of monochorionic twin pregnancies. So we can provide some reference for the prenatal health care, complication prevention and prenatal outcome. Methods We divided 489 cases of twin pregnancies into two groups: monochorionic twin and dichorionic twin and compared the clinical features of them. At last, we used the logistic regression analysis method to analyze the risk factors of selective intrauterine growth restriction(sIUGR). Results The incidences of premature rupture of membranes and sIUGR were significant higher in monochorionic twin and twin-twin transfusion syndrome (TTTS) only exists in monochorionic twin. The weight of the newborn babies(both big and small babies)were significant lower in Monochorionic twin. The neonatal transfer rate was significant higher in monochorionic twin. Gestational weeks and weight of newborn babies are the high risk factors of sIUGR. Conclusions The type of chorion has a great influence to the pregnant period and the ending of maternal women. Monochorionic is a high risk factor of the sIUGR, which means that the main cause of sIUGR is from placenta, so it is a kind of “placental origin disease”.

scholarly journals The comparison of the perinatal outcomes in monochorionic twin pregnancies with and without selective intrauterine growth restriction

2021 ◽  
Vol 29 (1) ◽  
pp. 20-26
Author(s):  
Elif Fide Pişirgen ◽  
Münip Akalın ◽  
Oya Demirci ◽  
Pınar Kumru ◽  
Emine Eda Akalın
Keyword(s):  
Flow Pattern ◽  
Intrauterine Growth Restriction ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Artery Flow ◽  
Twin Pregnancies

Objective Both fetuses may be affected negatively as a result of the non-equal share of the placenta and vascular anastomoses in monochorionic pregnancies with selective intrauterine growth restriction (sIUGR). In our study, we aimed to investigate the perinatal outcomes of both larger and smaller fetuses in monochorionic pregnancies with and without sIUGR (non-sIUGR) separately. Methods A total of 196 monochorionic twin pregnancies were evaluated retrospectively between January 2013 and January 2019. The cases were grouped as sIUGR and non-sIUGR pregnancies. The pregnancies with sIUGR were also separated into sub-groups as the cases with normal umbilical flow pattern and the cases with abnormal umbilical flow pattern. The perinatal outcomes were investigated separately between the groups for larger and smaller fetuses. Results Of 153 monochorionic pregnancies included in the study, 17.6% (n=27) were sIUGR cases and 82.4% (n=126) were non-sIUGR cases. While the umbilical artery flow pattern was normal in 59.3% (n=16) of the pregnancies which developed sIUGR, 40.7% (n=11) of them had abnormal umbilical artery flow pattern. The preeclampsia rate was found significantly higher in sIUGR pregnancies than non-sIUGR pregnancies (25.9% vs. 11.1%, p=0.042). The need for intensive care for both larger and smaller newborns was significantly higher in sIUGR pregnancies compared to non-sIUGR pregnancies (p<0.001). Three (11.1%) of newborns in sIUGR pregnancies passed away during neonatal period. All of the newborns that passed away were the smaller newborns from sIUGR pregnancies with abnormal umbilical artery flow pattern. Conclusion The pregnancies with selective intrauterine growth restriction (sIUGR) are more associated with high risks in terms of perinatal outcomes compared to the pregnancies with non-sIUGR. In pregnancies developing sIUGR, the risk increases for larger fetus as well as smaller fetus. More prospective studies are needed to investigate whether this increased risk in the pregnancies with sIUGR is associated with prematurity which is more common or is a result of sIUGR.

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

2011 ◽  
Vol 14 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Yao-lung Chang ◽  
Shuenn-dyh Chang ◽  
An-shine Chao ◽  
Chao-nin Wang ◽  
Tzu-hao Wang ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Volume Flow ◽  
Growth Restriction ◽  
Intrauterine Fetal Death ◽  
Maximal Velocity ◽  
Monochorionic Twins ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
Venous Volume ◽  
Twin Pregnancies

This study was conducted to investigate the relationship among umbilical venous volume flow, birthweight and placental share in monochorionic twins with or without selective growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 51 monochorionic twin pregnancies were divided into two groups as with (group 1) and without (group 2) selective intrauterine growth restriction. Umbilical venous volume flow was calculated by multiplying the umbilical vein cross-sectional area by half of the maximal velocity around mid-trimester. The placentas were cut along the vascular equator into two individual placental masses. The discordance of birthweight was calculated as [(birthweight of larger twin—birthweight of smaller twin)/birthweight of larger twin 100%]. The discordances of umbilical venous volume flow and placental share were calculated in a similar fashion. The median umbilical venous volume flow discordances (68.4% and 15.3% in groups 1 and 2 monochorionic twins, respectively) were similar and correlated well with the placental share discordances (66.6% and 18.5% in groups 1 and 2 monochorionic twins, respectively) but not with the birthweight discordance (28.6% and 6.4% in groups 1 and 2 monochorionic twins, respectively) in both groups. We concluded that the umbilical venous volume flow discordance reflects the placental share discordance rather than the birthweight discordance in monochorionic twin pregnancies.

Perinatal Outcome of Selective Intrauterine Growth Restriction in Monochorionic Twins: Evaluation of a Retrospective Cohort in a Developing Country

2021 ◽  
pp. 1-5
Author(s):  
Carolina Aquino ◽  
Ana Elisa Rodrigues Baião ◽  
Paulo Roberto Nassar de Carvalho
Keyword(s):  
Intrauterine Growth Restriction ◽  
Retrospective Cohort ◽  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Type I ◽  
Monochorionic Twin ◽  
Intrauterine Growth ◽  
Twin Pregnancies ◽  
Estimated Fetal Weight

Abstract Selective intrauterine growth restriction (sIUGR) in monochorionic twin pregnancies is associated with greater morbidity and mortality for both fetuses when compared to singleton and dichorionic pregnancies. This retrospective cohort study aimed to assess the perinatal outcomes of monochorionic twin pregnancies affected by this disorder and conducted expectantly, by analyzing the results according to the end-diastolic flow in the umbilical artery Doppler of the smaller twin (type I: persistently forward/type II: persistently absent or reversed/type III: intermittently absent or reversed). Seventy-five monochorionic diamniotic twin pregnancies with sIUGR were included in this study. sIUGR was defined by estimated fetal weight below the 3rd centile for gestational age, or below the 10th centile, when associated with at least one of the following three criteria: abdominal circumference below the 10th percentile, umbilical artery pulsatility index of the smaller twin above the 95th percentile, or estimated fetal weight discordance of 25% or more. Perinatal outcomes were analyzed from the prenatal period to hospital discharge and included perinatal death, neurological injury, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and sepsis. The mortality rate was 1.33% in this cohort. The overall morbidity rate was lower in type I twin pregnancies. In conclusion, this study shows that sIUGR type I has lower morbidity than types II and III in expectant management.

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