Fetal Diagnosis and Therapy
Original Paper
Significance of Velamentous Cord Insertion for Twin-Twin Transfusion SyndromeYonetani N. · Ishii K. · Kawamura H. · Mabuchi A. · Hayashi S. · Mitsuda N.Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
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Article / Publication Details
Received: November 03, 2014
Accepted: March 12, 2015
Published online: April 28, 2015
Issue release date: December 2015
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 4
ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)
For additional information: https://www.karger.com/FDT
Abstract
Introduction: The objective of this study was to evaluate the actual association between velamentous cord insertion (VCI) and twin-twin transfusion syndrome (TTTS) in the native cohort concerning the natural history of monochorionic twin pregnancies. Material and Methods: All monochorionic diamniotic twin pregnancies who received prenatal care from <16 weeks of gestation until delivery at our center between 2004 and 2013 were included in this retrospective cohort study. Macroscopically defined cord insertion site was recorded as velamentous, marginal, or central. The effects of VCI on TTTS and a composite of adverse outcomes, including abortion, death, and neurological morbidities ≤28 days of age, were evaluated with a multiple logistic regression model. Results: A total of 357 monochorionic diamniotic twin pregnancies were analyzed. VCI in both twins was noted in 2.5% of cases and VCI in at least one twin was noted in 22.1% of cases. The incidence of TTTS was 8.4%; the incidence of a composite of adverse outcomes in at least one twin was 9.8%. There was no correlation between VCI and TTTS as well as a composite of adverse outcomes. Discussion: VCI in monochorionic twin pregnancies was not a risk factor for TTTS and severe perinatal morbidities.
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References
- Hack KE, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK, Bode CL, Koopman-Esseboom C, Visser GH: Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG 2008;115:58-67.
- Dube J, Dodds L, Armson BA: Does chorionicity or zygosity predict adverse perinatal outcomes in twins? Am J Obstet Gynecol 2002;186:579-583.
- Ortibus E, Lopriore E, Deprest J, Vandenbussche FP, Walther FJ, Diemert A, Hecher K, Lagae L, De Cock P, Lewi PJ, Lewi L: The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol 2009;200:494.
- Lewi L, Jani J, Blickstein I, Huber A, Gucciardo L, Van Mieghem T, Done E, Boes AS, Hecher K, Gratacos E, Lewi P, Deprest J: The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol 2008;199:514.
- Nakayama S, Ishii K, Kawaguchi H, Hayashi S, Hidaka N, Murakoshi T, Mitsuda N: Perinatal outcome of monochorionic diamniotic twin pregnancies managed from early gestation at a single center. J Obstet Gynaecol Res 2012;38:692-697.
- Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y: Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 2004;351:136-144.
- Sago H, Hayashi S, Saito M, Hasegawa H, Kawamoto H, Kato N, Nanba Y, Ito Y, Takahashi Y, Murotsuki J, Nakata M, Ishii K, Murakoshi T: The outcome and prognostic factors of twin-twin transfusion syndrome following fetoscopic laser surgery. Prenat Diagn 2010;30:1185-1191.
- Rossi AC, D'Addario V: Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. Am J Obstet Gynecol 2008;198:147-152.
- van Klink JM, Koopman HM, van Zwet EW, Middeldorp JM, Walther FJ, Oepkes D, Lopriore E: Improvement in neurodevelopmental outcome in survivors of twin-twin transfusion syndrome treated with laser surgery. Am J Obstet Gynecol 2014;210:540.
- Lewi L, Gucciardo L, Van Mieghem T, de Koninck P, Beck V, Medek H, Van Schoubroeck D, Devlieger R, De Catte L, Deprest J: Monochorionic diamniotic twin pregnancies: natural history and risk stratification. Fetal Diagn Ther 2010;27:121-133.
- Lopriore E, Slaghekke F, Oepkes D, Middeldorp JM, Vandenbussche FP, Walther FJ: Clinical outcome in neonates with twin anemia-polycythemia sequence. Am J Obstet Gynecol 2010;203:54.
- Nicolini U, Pisoni MP, Cela E, Roberts A: Fetal blood sampling immediately before and within 24 hours of death in monochorionic twin pregnancies complicated by single intrauterine death. Am J Obstet Gynecol 1998;179:800-803.
- Gratacos E, Lewi L, Munoz B, Acosta-Rojas R, Hernandez-Andrade E, Martinez JM, Carreras E, Deprest J: A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 2007;30:28-34.
- Sato Y, Benirschke K: Increased prevalence of fetal thrombi in monochorionic-twin placentas. Pediatrics 2006;117:e113-e117.
- Kent EM, Breathnach FM, Gillan JE, McAuliffe FM, Geary MP, Daly S, Higgins JR, Dornan J, Morrison JJ, Burke G, Higgins S, Carroll S, Dicker P, Manning F, Malone FD: Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective esprit study. Am J Obstet Gynecol 2011;205:376.
- Fries MH, Goldstein RB, Kilpatrick SJ, Golbus MS, Callen PW, Filly RA: The role of velamentous cord insertion in the etiology of twin-twin transfusion syndrome. Obstet Gynecol 1993;81:569-574.
- Hack KE, Nikkels PG, Koopman-Esseboom C, Derks JB, Elias SG, van Gemert MJ, Visser GH: Placental characteristics of monochorionic diamniotic twin pregnancies in relation to perinatal outcome. Placenta 2008;29:976-981.
- Lopriore E, Sueters M, Middeldorp JM, Oepkes D, Walther FJ, Vandenbussche FP: Velamentous cord insertion and unequal placental territories in monochorionic twins with and without twin-to-twin-transfusion syndrome. Am J Obstet Gynecol 2007;196:159.
- Costa-Castro T, De Villiers S, Montenegro N, Severo M, Oepkes D, Matias A, Lopriore E: Velamentous cord insertion in monochorionic twins with or without twin-twin transfusion syndrome: does it matter? Placenta 2013;34:1053-1058.
- Hanley ML, Ananth CV, Shen-Schwarz S, Smulian JC, Lai YL, Vintzileos AM: Placental cord insertion and birth weight discordancy in twin gestations. Obstet Gynecol 2002;99:477-482.
- De Paepe ME, Shapiro S, Young L, Luks FI: Placental characteristics of selective birth weight discordance in diamniotic-monochorionic twin gestations. Placenta 2010;31:380-386.
- Lopriore E, Pasman SA, Klumper FJ, Middeldorp JM, Walther FJ, Oepkes D: Placental characteristics in growth-discordant monochorionic twins: a matched case-control study. Placenta 2012;33:171-174.
- Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M: Staging of twin-twin transfusion syndrome. J Perinatol 1999;19:550-555.
- Robinson LK, Jones KL, Benirschke K: The nature of structural defects associated with velamentous and marginal insertion of the umbilical cord. Am J Obstet Gynecol 1983;146:191-193.
- Ebbing C, Kiserud T, Johnsen SL, Albrechtsen S, Rasmussen S: Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies. PLoS One 2013;8:e70380.
- Lewi L, Lewi P, Diemert A, Jani J, Gucciardo L, Van Mieghem T, Done E, Gratacos E, Huber A, Hecher K, Deprest J: The role of ultrasound examination in the first trimester and at 16 weeks' gestation to predict fetal complications in monochorionic diamniotic twin pregnancies. Am J Obstet Gynecol 2008;199:493.
Article / Publication Details
Received: November 03, 2014
Accepted: March 12, 2015
Published online: April 28, 2015
Issue release date: December 2015
Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 4
ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)
For additional information: https://www.karger.com/FDT
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