Atallah A, Bolze P-A, Buenerd A, Marino S, Massardier J, Gaucherand P, Massoud M
Service d'obstétrique, hospices civils de Lyon, hôpital femme-mère-enfant, 59, boulevard Pinel, 69677 Bron cedex, France.
Service d'anatomopathologie, hospices civils de Lyon, hôpital femme-mère-enfant, 59, boulevard Pinel, 69677 Bron cedex, France.
Gynecol Obstet Fertil Senol. 2017 May;45(5):269-275. doi: 10.1016/j.gofs.2017.03.002. Epub 2017 May 3.
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.
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. Umbilical chords were catheterized and dye injected for macroscopic analysis of angioarchitecture at the anatomopathology department. Placentas treated with laser foetoscopic surgery were excluded.
A total of 126 placentas were injected in the post-partum period. In total, 95% (119/126) of the placentas presented arteriovenous anastomoses (AVA). Median number of AVA was 7. The prevalence of at least one velamentous cord insertion was higher in TOPS and selective intrauterine growth restrictions P<0.01 and P<0.01 respectively, compared to uneventful pregnancies. Arterio-arterial anastomoses (AAA) were present in 82.7% (77/93) of uneventful placentas versus 33.3% of TOPS (P<0.01) and 28.5% of TAPS (P<0.01). The prevalence of veno-venous anastomoses was significantly higher in TOPS (P<0.01). All TAPS placentas showed marginal arteriovenous anastomoses. In TRAP placenta, the acardiac twin had no specific vascular territory.
The study confirms literature findings on prevalence of vascular anastomoses in monochorial placentas, suggesting the protective role of AAA in TOPS and TAPS. The role of VVA is yet hard to determinate. Macroscopic observations of monochorionic placentas are valuable and essential keys for understanding, managing and treating anastomotic syndromes.
本研究旨在比较合并双胎羊水过少-羊水过多序列征（TOPS）、双胎贫血-红细胞增多序列征（TAPS）、双胎反向动脉灌注序列征（TRAP）和选择性胎儿生长受限（sIUGR）的单绒毛膜胎盘血管结构与正常无异常的单绒毛膜胎盘。
2012年12月至2015年12月期间，在里昂妇幼医院的多胎妊娠护理中心对单绒毛膜胎盘进行了研究。脐血管插管并注入染料，以便在解剖病理科对血管结构进行宏观分析。排除接受激光胎儿镜手术治疗的胎盘。
产后共对126个胎盘进行了注射。总体而言，95%（119/126）的胎盘存在动静脉吻合（AVA）。AVA的中位数为7。与正常妊娠相比，TOPS和选择性胎儿生长受限中至少有一个帆状脐带附着的发生率分别更高（P<0.01和P<0.01）。82.7%（77/93）的正常胎盘存在动脉-动脉吻合（AAA），而TOPS中为33.3%（P<0.01），TAPS中为28.5%（P<0.01）。TOPS中静脉-静脉吻合的发生率显著更高（P<0.01）。所有TAPS胎盘均显示边缘动静脉吻合。在TRAP胎盘中，无心双胎没有特定的血管区域。
该研究证实了文献中关于单绒毛膜胎盘血管吻合发生率的发现，提示AAA在TOPS和TAPS中的保护作用。VVA的作用尚难以确定。单绒毛膜胎盘的宏观观察对于理解、管理和治疗吻合综合征是有价值且必不可少的关键。
