Individual placental territories after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome

Rubén A. Quintero, Josep M. Martínez, Jaime López, Carlos Bermúdez, Carlos Becerra, Walter Morales, Jorge Arroyo

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: Intrauterine fetal death of one or both twins after laser therapy (selective photocoagulation of communicating vessels) may occur, in part, from insufficient individual placental mass. The objective of this study was to assess the percentage of individual placental mass (individual placental territory) that is associated with fetal survival in twin-twin transfusion syndrome after selective photocoagulation of communicating vessels. Study design: Placentas from 72 patients with selective photocoagulation of communicating vessels-treated twin-twin transfusion syndrome without intrauterine fetal death and from 61 monochorionic pregnancies without twin-twin transfusion syndrome (control subjects) were assessed. The placentas were weighed fresh (total placental mass) and cut along the vascular equator, which yielded the individual placental mass and the individual placental territory. Patency of anastomoses was ruled out with air-injection. The individual fetoplacental ratio was obtained by dividing birth weight by the corresponding individual placental mass. Results: The 5th percentile individual placental territory that was associated with fetal survival was 27% in control subjects and 18% in cases with twin-twin transfusion syndrome, with a minimum of 10% to 14%, respectively. There were no differences in total placental mass, individual placental mass, individual placental territory, or individual fetoplacental ratio between pregnancies with twin-twin transfusion syndrome and control subjects. However, corrected for gestational age, the birth weight of recipient and donor twins were significantly smaller than control subjects. The individual placental territory of donors was statistically smaller than that of recipients. Individual placental territories were not different within control subjects. Conclusion: Fetal survival typically is associated with at least 18% of individual placental territory after selective photocoagulation of communicating vessels for twin-twin transfusion syndrome, but it can occur with as little as 10% to 14% individual placental territory. Decreased birth weight of the donor twin could result from relative decreased percentage of individual placental territory or from the loss of nutrients to the recipient twin. Decreased birth weight of the recipient twin could result from partial deprivation of functional placental tissue after surgery. Our findings may contribute to the understanding of normal and pathologic monochorionic twin gestations, in the counseling of patients, and potentially to the improvement of surgical treatment of twin-twin transfusion syndrome.

Original languageEnglish
Pages (from-to)1112-1118
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume192
Issue number4
DOIs
StatePublished - Apr 1 2005

Fingerprint

Fetofetal Transfusion
Light Coagulation
Lasers
Birth Weight
Fetal Death
Tissue Donors
Pregnancy
Placenta
Survival
Laser Therapy
Gestational Age
Blood Vessels
Counseling
Air
Food
Injections

Keywords

  • Fetus/placental ratio
  • Laser photocoagulation
  • Placental territory
  • Twin-twin transfusion syndrome
  • Twins

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Individual placental territories after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. / Quintero, Rubén A.; Martínez, Josep M.; López, Jaime; Bermúdez, Carlos; Becerra, Carlos; Morales, Walter; Arroyo, Jorge.

In: American Journal of Obstetrics and Gynecology, Vol. 192, No. 4, 01.04.2005, p. 1112-1118.

Research output: Contribution to journalArticle

Quintero, Rubén A. ; Martínez, Josep M. ; López, Jaime ; Bermúdez, Carlos ; Becerra, Carlos ; Morales, Walter ; Arroyo, Jorge. / Individual placental territories after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. In: American Journal of Obstetrics and Gynecology. 2005 ; Vol. 192, No. 4. pp. 1112-1118.
@article{1d9c5f91f0a24167b3fa56de8e715e0a,
title = "Individual placental territories after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome",
abstract = "Objective: Intrauterine fetal death of one or both twins after laser therapy (selective photocoagulation of communicating vessels) may occur, in part, from insufficient individual placental mass. The objective of this study was to assess the percentage of individual placental mass (individual placental territory) that is associated with fetal survival in twin-twin transfusion syndrome after selective photocoagulation of communicating vessels. Study design: Placentas from 72 patients with selective photocoagulation of communicating vessels-treated twin-twin transfusion syndrome without intrauterine fetal death and from 61 monochorionic pregnancies without twin-twin transfusion syndrome (control subjects) were assessed. The placentas were weighed fresh (total placental mass) and cut along the vascular equator, which yielded the individual placental mass and the individual placental territory. Patency of anastomoses was ruled out with air-injection. The individual fetoplacental ratio was obtained by dividing birth weight by the corresponding individual placental mass. Results: The 5th percentile individual placental territory that was associated with fetal survival was 27{\%} in control subjects and 18{\%} in cases with twin-twin transfusion syndrome, with a minimum of 10{\%} to 14{\%}, respectively. There were no differences in total placental mass, individual placental mass, individual placental territory, or individual fetoplacental ratio between pregnancies with twin-twin transfusion syndrome and control subjects. However, corrected for gestational age, the birth weight of recipient and donor twins were significantly smaller than control subjects. The individual placental territory of donors was statistically smaller than that of recipients. Individual placental territories were not different within control subjects. Conclusion: Fetal survival typically is associated with at least 18{\%} of individual placental territory after selective photocoagulation of communicating vessels for twin-twin transfusion syndrome, but it can occur with as little as 10{\%} to 14{\%} individual placental territory. Decreased birth weight of the donor twin could result from relative decreased percentage of individual placental territory or from the loss of nutrients to the recipient twin. Decreased birth weight of the recipient twin could result from partial deprivation of functional placental tissue after surgery. Our findings may contribute to the understanding of normal and pathologic monochorionic twin gestations, in the counseling of patients, and potentially to the improvement of surgical treatment of twin-twin transfusion syndrome.",
keywords = "Fetus/placental ratio, Laser photocoagulation, Placental territory, Twin-twin transfusion syndrome, Twins",
author = "Quintero, {Rub{\'e}n A.} and Mart{\'i}nez, {Josep M.} and Jaime L{\'o}pez and Carlos Berm{\'u}dez and Carlos Becerra and Walter Morales and Jorge Arroyo",
year = "2005",
month = "4",
day = "1",
doi = "10.1016/j.ajog.2004.12.018",
language = "English",
volume = "192",
pages = "1112--1118",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Individual placental territories after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome

AU - Quintero, Rubén A.

AU - Martínez, Josep M.

AU - López, Jaime

AU - Bermúdez, Carlos

AU - Becerra, Carlos

AU - Morales, Walter

AU - Arroyo, Jorge

PY - 2005/4/1

Y1 - 2005/4/1

N2 - Objective: Intrauterine fetal death of one or both twins after laser therapy (selective photocoagulation of communicating vessels) may occur, in part, from insufficient individual placental mass. The objective of this study was to assess the percentage of individual placental mass (individual placental territory) that is associated with fetal survival in twin-twin transfusion syndrome after selective photocoagulation of communicating vessels. Study design: Placentas from 72 patients with selective photocoagulation of communicating vessels-treated twin-twin transfusion syndrome without intrauterine fetal death and from 61 monochorionic pregnancies without twin-twin transfusion syndrome (control subjects) were assessed. The placentas were weighed fresh (total placental mass) and cut along the vascular equator, which yielded the individual placental mass and the individual placental territory. Patency of anastomoses was ruled out with air-injection. The individual fetoplacental ratio was obtained by dividing birth weight by the corresponding individual placental mass. Results: The 5th percentile individual placental territory that was associated with fetal survival was 27% in control subjects and 18% in cases with twin-twin transfusion syndrome, with a minimum of 10% to 14%, respectively. There were no differences in total placental mass, individual placental mass, individual placental territory, or individual fetoplacental ratio between pregnancies with twin-twin transfusion syndrome and control subjects. However, corrected for gestational age, the birth weight of recipient and donor twins were significantly smaller than control subjects. The individual placental territory of donors was statistically smaller than that of recipients. Individual placental territories were not different within control subjects. Conclusion: Fetal survival typically is associated with at least 18% of individual placental territory after selective photocoagulation of communicating vessels for twin-twin transfusion syndrome, but it can occur with as little as 10% to 14% individual placental territory. Decreased birth weight of the donor twin could result from relative decreased percentage of individual placental territory or from the loss of nutrients to the recipient twin. Decreased birth weight of the recipient twin could result from partial deprivation of functional placental tissue after surgery. Our findings may contribute to the understanding of normal and pathologic monochorionic twin gestations, in the counseling of patients, and potentially to the improvement of surgical treatment of twin-twin transfusion syndrome.

AB - Objective: Intrauterine fetal death of one or both twins after laser therapy (selective photocoagulation of communicating vessels) may occur, in part, from insufficient individual placental mass. The objective of this study was to assess the percentage of individual placental mass (individual placental territory) that is associated with fetal survival in twin-twin transfusion syndrome after selective photocoagulation of communicating vessels. Study design: Placentas from 72 patients with selective photocoagulation of communicating vessels-treated twin-twin transfusion syndrome without intrauterine fetal death and from 61 monochorionic pregnancies without twin-twin transfusion syndrome (control subjects) were assessed. The placentas were weighed fresh (total placental mass) and cut along the vascular equator, which yielded the individual placental mass and the individual placental territory. Patency of anastomoses was ruled out with air-injection. The individual fetoplacental ratio was obtained by dividing birth weight by the corresponding individual placental mass. Results: The 5th percentile individual placental territory that was associated with fetal survival was 27% in control subjects and 18% in cases with twin-twin transfusion syndrome, with a minimum of 10% to 14%, respectively. There were no differences in total placental mass, individual placental mass, individual placental territory, or individual fetoplacental ratio between pregnancies with twin-twin transfusion syndrome and control subjects. However, corrected for gestational age, the birth weight of recipient and donor twins were significantly smaller than control subjects. The individual placental territory of donors was statistically smaller than that of recipients. Individual placental territories were not different within control subjects. Conclusion: Fetal survival typically is associated with at least 18% of individual placental territory after selective photocoagulation of communicating vessels for twin-twin transfusion syndrome, but it can occur with as little as 10% to 14% individual placental territory. Decreased birth weight of the donor twin could result from relative decreased percentage of individual placental territory or from the loss of nutrients to the recipient twin. Decreased birth weight of the recipient twin could result from partial deprivation of functional placental tissue after surgery. Our findings may contribute to the understanding of normal and pathologic monochorionic twin gestations, in the counseling of patients, and potentially to the improvement of surgical treatment of twin-twin transfusion syndrome.

KW - Fetus/placental ratio

KW - Laser photocoagulation

KW - Placental territory

KW - Twin-twin transfusion syndrome

KW - Twins

UR - http://www.scopus.com/inward/record.url?scp=16844382011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=16844382011&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2004.12.018

DO - 10.1016/j.ajog.2004.12.018

M3 - Article

C2 - 15846189

AN - SCOPUS:16844382011

VL - 192

SP - 1112

EP - 1118

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 4

ER -