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Monochorionic twins

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https://www.readbyqxmd.com/read/28532678/selective-intrauterine-growth-restriction-in-monochorionic-diamniotic-twin-pregnancies
#1
REVIEW
Mar Bennasar, Elisenda Eixarch, Josep Maria Martinez, Eduard Gratacós
Selective intrauterine growth restriction (sIUGR) affects 10-15% of all monochorionic pregnancies. Early severe forms are associated with intrauterine demise or neurological adverse outcome for both twins. The characteristics of umbilical artery (UA) Doppler in the IUGR fetus determine three clinical types: (I) normal UA Doppler and associated with good prognosis; (II) persistently absent/reverse UA end-diastolic flow and associated with early deterioration of the IUGR twin and very preterm delivery; (III) intermittently absent/reverse end-diastolic flow in the UA, and associated with unexpected fetal demise or neurological injury in one or both twins...
May 19, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28527483/single-fetal-death-in-monochorionic-twin-pregnancy-co-twin-prognosis-and-neonatal-outcome
#2
Emídio Vale-Fernandes, Joana Dias, Belandina Gil, Alexandra Cadilhe
The incidence of single fetal death in twin pregnancy varies from 0.5% - 6.8%, leaving the surviving fetus with increased morbi-mortality. The prognosis is worse in monochorionic pregnancies. In addressing these cases it should be noted referral to tertiary center with differentiated perinatal support, induction of fetal lung maturation and termination of pregnancy if there's loss of fetal well-being or possibility of maternal complications and suspected neurological sequelae in the surviving fetus. The risk of iatrogenic prematurity should always be weighed with the possible consequences arising from the fetus staying in a hostile uterine environment...
February 27, 2017: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/28508528/competing-risks-model-in-screening-for-preeclampsia-in-twin-pregnancies-by-maternal-characteristics-and-medical-history
#3
Carla Francisco, David Wright, Zsófia Benkő, Argyro Syngelaki, Kypros H Nicolaides
OBJECTIVE: A survival-time regression model for the gestational age at delivery with preeclampsia (PE) in singleton pregnancies using maternal demographic characteristics and medical history was previously reported. The objective of this paper is to extend this model for dichorionic (DC) and monochorionic (MC) twin pregnancies. METHODS: The study population included 1,789 DC and 430 MC twin pregnancies and 93,297 singleton pregnancies. A survival-time model for the gestational age at delivery with PE was developed from variables of maternal characteristics and history...
May 15, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28505609/disentanglement-of-discordant-monochorionic-monoamniotic-twins-in-a-triplet-pregnancy-an-innovative-approach-utilizing-fetoscopic-laser-coagulation-with-micro-laparoscopic-scissor-dissection
#4
https://www.readbyqxmd.com/read/28501032/-perinatal-outcome-in-relation-to-chorionicity-in-twin-pregnancy
#5
Marta Machado, Elsa Lima Teixeira, Lígia Maria Ferreira, Filipa Rodrigues, Raquel Henriques, Eulália Afonso
INTRODUCTION: The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. MATERIAL AND METHODS: Retrospective study of all twins born in a tertiary center from January 2004 to December 2013...
January 31, 2017: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/28488223/ultrasonic-identification-of-pump-twin-by-dual-gate-doppler-in-a-monochorionic-triamniotic-triplet-twin-reversed-arterial-perfusion-sequence-before-preventative-radiofrequency-ablation-a-case-report
#6
Yuichiro Takahashi, Shigenori Iwagaki, Rika Chiaki, Kazuhiko Asai, Masako Matsui, Ichiro Kawabata
We performed a dual-gate Doppler examination for a twin reversed arterial perfusion (TRAP) sequence in a monochorionic-triamniotic triplet pregnancy at 16 weeks of gestation and were able to identify the pump twin by arterial pulse rate synchronicity. We performed radiofrequency ablation to coagulate blood flow in the acardius at 16 weeks of gestation without any postoperative complication. At 29 weeks of gestation, we performed a cesarean section due to preterm rupture of the membranes and the patient delivered 1167/1237-g female neonates and a macerated acardius...
May 9, 2017: Journal of Medical Ultrasonics
https://www.readbyqxmd.com/read/28487021/increased-risk-of-placental-abruption-after-solomon-laser-treatment-of-twin-twin-transfusion-syndrome
#7
M M Lanna, S Faiola, D Consonni, M A Rustico
To evaluate the relative risk of placental abruption in monochorionic (MC) twin pregnancies complicated with twin-to-twin transfusion syndrome (TTTS) and treated with endoscopic laser coagulation of placental vessels (ELCPV). A retrospective analysis from January 2004 and December 2015 of 373 TTTS pregnancies, treated with selective ELCPV until January 2012 (287 cases), after which the Solomon technique was introduced (86 cases), compared with 243 normal MC pregnancies. A significant improvement in perinatal survival was observed after the introduction of the Solomon technique when compared to the selective procedure (77% vs 54%, p < 0...
May 2017: Placenta
https://www.readbyqxmd.com/read/28484895/diagnosis-of-umbilical-cord-entanglement-in-a-monochorionic-diamniotic-twin-pregnancy-with-spontaneous-septostomy-of-the-dividing-membranes-using-dual-gate-doppler-imaging
#8
Ayumu Ito, Masahiko Nakata, Ayako Oji, Mayumi Takano, Nahomi Umemura, Sumito Nagasaki, Toshimitsu Maemura, Mineto Morita
Umbilical cord entanglement is the leading cause of fetal mortality in monoamniotic twin pregnancies and a pseudo monoamniotic environment. Published methods for detecting this complication include color Doppler and pulsed Doppler sonography; however, no method provides an absolute diagnosis. In this case, we report the diagnosis of umbilical cord entanglement using dual-gate Doppler imaging. A 35-year-old woman was referred to our hospital at 28 weeks of gestation for prenatal management because of diagnosis of a monochorionic diamniotic twin pregnancy with spontaneous septostomy of the dividing membranes...
May 8, 2017: Journal of Medical Ultrasonics
https://www.readbyqxmd.com/read/28479073/-macroscopic-description-of-placental-vascular-anastomoses-after-dye-injection-for-the-comprehension-of-monochorionic-pregnancy-complications
#9
A Atallah, P-A Bolze, A Buenerd, S Marino, J Massardier, P Gaucherand, M Massoud
OBJECTIVES: The aim of the study is to compare placental monochorionic angioarchitecture complicated with twin-oligohydramnios-polyhydramnios sequence (TOPS), twin anemia polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) and selective intra uterine growth restriction (sIUGR) to normal uneventful monochorionic placenta. METHODS: Between December 2012 and December 2015, monochorionic placenta has been studied at the multiple pregnancy care center of the Femme-Mère-Enfant Hospital in Lyon...
May 2017: Gynecologie, Obstetrique, Fertilite & Senologie
https://www.readbyqxmd.com/read/28460542/hematological-disorders-at-birth-in-complicated-monochorionic-twins
#10
Lianne Verbeek, Femke Slaghekke, Marieke Sueters, Johanna M Middeldorp, Frans J Klumper, Monique C Haak, Dick Oepkes, Enrico Lopriore
Monochorionic twins are at risk of severe complications including twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS) and acute peripartum TTTS. The pathophysiology is based on inter-twin blood transfusion through placental vascular anastomoses. Areas covered: This review focuses on the incidence, management and outcome of neonatal hematological complications at birth in TTTS, TAPS and acute peripartum TTTS. Expert commentary: Hematological disorders are often present at birth in monochorionic twins and include acute or chronic anemia, polycythemia and thrombocytopenia...
May 10, 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28455084/recipient-umbilical-artery-elongation-redundancy-in-twin-twin-transfusion-syndrome
#11
Roopali Donepudi, Lovepreet K Mann, Christoph Wohlmuth, Anthony Johnson, Michael W Bebbington, Kenneth J Moise, David S Boudreaux, Helena Gardiner, Ramesha Papanna
BACKGROUND: Chronic hypertension in adults causes arterial lengthening in major arteries, but the effects of early fetal hypertension on the twin-twin transfusion syndrome (TTTS) recipient's vascular architecture remains unknown. OBJECTIVES: We hypothesize that arterial cord redundancy is related to recipient hypertension and subsequent heart failure. Our objectives were: 1) to establish a 3D color Doppler ultrasound method of measuring umbilical arterial (UA) length relative to its corresponding venous segment in the Umbilical cord using AV-angle, 2) to compare recipient AV-angle to gestational age-matched controls, and 3) to test the association of AV-angle with recipient heart failure...
April 25, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28448801/the-placental-factor-in-spontaneous-preterm-birth-in-twin-vs-singleton-pregnancies
#12
Eran Weiner, Ann Dekalo, Ohad Feldstein, Elad Barber, Letizia Schreiber, Jacob Bar, Michal Kovo
OBJECTIVE: The association between infection and inflammatory response in singleton preterm birth (PTB) is well established, yet, less is known about PTB in twins. We aimed to compare the placental component and pregnancy outcome in pregnancies complicated with PTB of singletons vs. twin deliveries. We hypothesized that due to different underlying mechanisms, placental inflammatory lesions will be more prevalent in placentas derived from singleton pregnancies than twins. STUDY DESIGN: Labor characteristics, neonatal outcome and placental histopathology reports of spontaneous PTB at 24-33(6)/7 weeks, from 1/2008-12/2015, were reviewed...
April 22, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28444780/fetal-brain-injury-in-complicated-monochorionic-pregnancies-diagnostic-yield-of-prenatal-mri-following-surveillance-ultrasound-and-influence-on-prognostic-counselling
#13
Alice Robinson, Mark Teoh, Andrew Edwards, Michael Fahey, Stacy Goergen
OBJECTIVE: This study aimed to determine the additional diagnostic information provided by prenatal (fetal) magnetic resonance imaging (pMRI) following tertiary ultrasound (US) for fetal cranial abnormalities in complicated monochorionic gestations. METHODS: Women with complicated monochorionic gestations complicated by twin-twin transfusion syndrome, co-twin demise (CD), selective intrauterine growth restriction, and/or twin anaemia-polycythaemia sequence who were referred for pMRI after tertiary US were included...
April 26, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/28444191/risks-of-miscarriage-or-preterm-delivery-in-trichorionic-and-dichorionic-triplet-pregnancies-with-embryo-reduction-versus-expectant-management-a-systematic-review-and-meta-analysis
#14
C Anthoulakis, T Dagklis, A Mamopoulos, A Athanasiadis
STUDY QUESTION: Is pregnancy outcome in triplet pregnancies improved with embryo reduction (ER) to twins compared to expectant management? SUMMARY ANSWER: In trichorionic triplet pregnancies, ER to twins reduces the risk of preterm birth (<34 weeks) without significantly increasing the risk of miscarriage (<24 weeks), whereas in dichorionic triplet pregnancies, the results are inconclusive. WHAT IS KNOWN ALREADY: Triplet pregnancies are associated with a high risk of miscarriage and preterm birth...
June 1, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28441900/placental-nfe2l2-is-discordantly-activated-in-monochorionic-twins-with-selective-intrauterine-growth-restriction-and-possibly-regulated-by-hypoxia
#15
Jing Wu, Zhiming He, Yu Gao, Guanglan Zhang, Xuan Huang, Qun Fang
INTRODUCTION: Nuclear factor, erythroid 2 like 2 (NFE2L2) is an important transcription factor that protects cells from oxidative stress (OS). NFE2L2 deficiency in placentas is associated with pregnancy complications. We have demonstrated that elevated OS existed in placental shares of the smaller fetus in selective intrauterine growth restriction (sIUGR); however, the role of NFE2L2 in the development of sIUGR remains unknown. In this study, we examined the levels of NFE2L2 and heme oxygenase 1 (HMOX1), a major antioxidant regulated by NFE2L2, in sIUGR placentas...
April 25, 2017: Free Radical Research
https://www.readbyqxmd.com/read/28422403/blood-chimerism-in-dizygotic-monochorionic-twins-during-5-years-observation
#16
M H Dziegiel, M H Hansen, S Haedersdal, A N Barrett, K Rieneck, K M Main, A T Hansen, F B Clausen
Dizygotic monochorionic twin pregnancies can result in blood chimerism due to in utero twin-to-twin exchange of stem cells. In this case, we examined the proportion of allogeneic red blood cells by flow cytometry and the proportion of allogeneic nucleated cells by digital polymerase chain reaction at 7 months and again at 5 years. We found an increase in the proportion of allogeneic cells from 63% to 89% in one twin, and a similar increase in autologous cells in the other twin from 57% to 84%. A paradigm for stem cell therapy could be modeled on this case: induction of tolerance and chimerism by antenatal transfusion of donor stem cells...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28403975/-fetoscopic-laser-coagulation-in-200%C3%A2-consecutive-monochorionic-pregnancies-with-twin-twin-transfusion-syndrome
#17
L Lecointre, N Sananès, A S Weingertner, A Gaudineau, C Akladios, V Cavillon, B Langer, R Favre
OBJECTIVES: To report preoperative data, surgical characteristics, complications and perinatal outcome of twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery, to analyze predictors of neonatal survival and to compare the 100 most recent cases with the older 100. MATERIALS AND METHODS: Observational cohort moncentric study of 200 cases of TTTS consecutively treated with fetoscopic laser coagulation between January 2004 and December 2014...
February 2017: J Gynecol Obstet Hum Reprod
https://www.readbyqxmd.com/read/28370497/cardiac-pathophysiology-in-twin-twin-transfusion-syndrome-new-insights-into-its-evolution
#18
Christoph Wohlmuth, David Boudreaux, Kenneth J Moise, Anthony Johnson, Ramesha Papanna, Michael Bebbington, Helena M Gardiner
OBJECTIVES: In twin-twin transfusion syndrome (TTTS) unbalanced transfer of vasoactive mediators and fluid from the 'donor' to the 'recipient' alters cardiovascular function. We evaluated cardiac function in 145 monochorionic-diamniotic (MCDA) pregnancies with and without TTTS. METHODS: Echocardiography was performed in uncomplicated MCDA, n = 26; TTTS stage I+II, n = 61; TTTS stage III+IV, n = 58, before selective fetoscopic laser photocoagulation (SFLP) in TTTS, and afterwards in 41 (34%) at a mean of 1...
March 31, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28355685/-clinical-outcome-and-placenta-characteristics-of-spontaneous-twin-anemia-polycythemia-sequence
#19
X J Wang, L Y Li, Y Wei, Y Y Zhao, P B Yuan
Objective: To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods: Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed, retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed...
March 25, 2017: Zhonghua Fu Chan Ke za Zhi
https://www.readbyqxmd.com/read/28351027/re-thinking-elective-single-embryo-transfer-increased-risk-of-monochorionic-twinning-a-systematic-review
#20
Margaret Dziadosz, Mark I Evans
BACKGROUND/OBJECTIVES: Multiple pregnancies have tripled in the United States over the past 3 decades. Attributed to increasing maternal age at delivery but more so assisted reproductive technological advances, an effort has been made to decrease twinning through elective single embryo transfer. We sought to review and evaluate risks of monochorionic twinning as a predictable consequence of increasing utilization of elective single embryo transfer on perinatal outcomes. Primary outcomes included twinning rates, fetal anomalies, growth, preterm birth, and mortality...
March 29, 2017: Fetal Diagnosis and Therapy
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