Lipa Michał, Kosinski Przemysław, Stanirowski Paweł, Wielgos Mirosław, Bomba-Opon Dorota
1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.
J Perinat Med. 2020 Jul 28;48(6):539-543. doi: 10.1515/jpm-2020-0028.
Objectives To evaluate the impact of placental anastomoses on the intrauterine growth of monochorionic (MC) twins. Methods A prospective study was conducted in a group of 53 MC twins. Intrapartally umbilical cords were clamped to identify placental sides corresponding to each twin. The postnatal dye injection technique was administered to evaluate vascular anastomoses, their number and type and visualize placental territory sharing patterns. Data from digital analysis were correlated with obstetrical follow-up. Results Vascular anastomoses were revealed in 88.7% of cases. Arteriovenous (AV) anastomoses occurred in 75.4% and arterioarterial (AA) in 71.1% while venovenous (VV) in 26.4%. In the subgroup of MC twins without placental anastomoses, significantly higher birthweight difference and discordance were revealed when compared to MC twins without anastomoses (382.0 vs. 22 g; P = 0.03 and 49.14% vs. 16.02%; P = 0.03). On the other hand, in subgroups of MC twins with at least one AA anastomosis, twins' birthweights were similar (p = ns) despite significantly higher placental territory sharing discordance (30.44% vs. 15.81%; P = 0.31). Conclusions Vascular anastomoses have a major impact on the intrauterine growth of MC twins. In certain cases, they may cause specific complications; however, in general, they regulate intertwin blood exchange and may compensate unequal placental territory.
目的 评估胎盘吻合对单绒毛膜（MC）双胎宫内生长的影响。方法 对一组53例MC双胎进行前瞻性研究。分娩时钳夹脐带以确定与每个胎儿对应的胎盘侧。采用产后染料注射技术评估血管吻合情况、其数量和类型，并观察胎盘区域共享模式。数字分析数据与产科随访数据相关。结果 88.7%的病例发现有血管吻合。动静脉（AV）吻合发生率为75.4%，动脉-动脉（AA）吻合为71.1%，静脉-静脉（VV）吻合为26.4%。在无胎盘吻合的MC双胎亚组中，与有吻合的MC双胎相比，出生体重差异和不一致性显著更高（382.0 vs. 22 g；P = 0.03和49.14% vs. 16.02%；P = 0.03）。另一方面，在至少有一个AA吻合的MC双胎亚组中，尽管胎盘区域共享不一致性显著更高（30.44% vs. 15.81%；P = 0.31），但双胎出生体重相似（p = 无统计学意义）。结论 血管吻合对MC双胎的宫内生长有重大影响。在某些情况下，它们可能导致特定并发症；然而，总体而言，它们调节双胎间的血液交换，并可能补偿不平等的胎盘区域。
