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Obstetrics & Gynecology 2008;112:753-758
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Placental Characteristics in Monochorionic Twins With and Without Twin Anemia–Polycythemia Sequence

E. Lopriore, MD, PhD1, J. Deprest, MD, PhD2, F. Slaghekke, MD3, D. Oepkes, MD, PhD3, J. M. Middeldorp, MD, PhD3, F. P. H. A. Vandenbussche, MD, PhD3 and L. Lewi, MD, PhD2

From the 1Division of Neonatology, Department of Pediatrics, Leiden University Medical Centre, Leiden, the Netherlands; 2Centre for Fetal Diagnosis and Therapy, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Belgium; and 3Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.

OBJECTIVE: To study the placental angioarchitecture of monochorionic placentas with and without twin anemia–polycythemia sequence.

METHODS: Eligible were all placentas from monochorionic twin gestations, not complicated by twin-to-twin transfusion syndrome and resulting in double survival. The study was conducted at two European Fetal Therapy Centers between 2002 and 2008. Placental angioarchitecture was evaluated using colored dye injection. Diagnosis of twin anemia–polycythemia sequence was based on the presence of large intertwin hemoglobin difference without the degree of amniotic fluid discordance that is required for the diagnosis of twin transfusion syndrome.

RESULTS: Three-hundred thirteen monochorionic twin pregnancies were eligible for the study but placental data could not be completed for 62 placentas (20%). This left 251 monochorionic twin pregnancies of which 11 (4%) fulfilled the criteria for twin anemia–polycythemia sequence. The median number of anastomoses in monochorionic placentas with and without twin anemia–polycythemia sequence was 3 (range: 2–5) and 7 (range: 0–25), respectively (P<.001). Small anastomoses were present in 91% (10/11) of twin anemia–polycythemia sequence-placentas compared with 5% (12/240) of cases without twin anemia–polycythemia sequence (P<.001). Arterioarterial anastomoses were absent in twin anemia–polycythemia sequence-placentas and present in 89% (213/240) of placentas without twin anemia–polycythemia sequence (P<.001).

CONCLUSION: Monochorionic twin placentas with twin anemia–polycythemia sequence are characterized by a paucity of anastomoses and the absence of arterioarterial anastomoses. The few anastomoses that are present in twin anemia–polycythemia sequence placentas are mostly small arteriovenous anastomoses.

LEVEL OF EVIDENCE: II






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