Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: Is there more than meets the eye? - 18/08/11
Abstract |
Objective |
This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion syndrome (TTTS) and to correlate these findings to clinical outcome.
Study design |
All cord vessels were injected with dyed barium sulphate. A digital photograph of the chorionic surface angioarchitecture and single-shot digital X-ray (Rx) angiograms were made. The presence and diameter of any missed anastomoses on the chorionic surface and of any hidden angiographic connections were determined.
Results |
Fifty placentas were analyzed, 7 of double intrauterine fetal death (IUFD) and 43 of double survivors. In 9 of 43 (21%) cases with double survival and in all 7 cases of double IUFD, missed anastomoses were identified that should have been ablated by laser coagulation (P < .001). There appeared to be a correlation between the type and diameter of missed anastomoses on the chorionic surface and the clinical outcome. Placentas with missed large arteriovenous/venoarterial anastomoses (AV/VA) (N = 8) were from cases with recurrent TTTS or double IUFD (unless compensated by a large arterioarterial anastomosis [AA]). Next, missed small AV/VA (N = 4) without AA resulted in isolated (ie, without TTTS) discordant hemoglobin levels requiring intrauterine transfusion. Finally, when there were no missed anastomoses (N = 34), TTTS had resolved in all cases and outcome was good, although 1 case had discordant hemoglobin values treated with a single intrauterine transfusion and 4 others had discordant hemoglobin at birth. On Rx angiography, potential hidden connections were present, all but 1 case.
Conclusion |
Coagulation of all anastomoses visible on the chorionic surface seems adequate to treat TTTS. However, hidden connections in the depth of the cotyledon could not be excluded and may be involved in lesser degrees of intertwin transfusion.
Le texte complet de cet article est disponible en PDF.Key words : Monochorionic placenta, Fetoscopic laser coagulation, Angiography, Twin-to-twin transfusion syndrome
Plan
| L. Lewi and J. Jani are beneficents from a grant of the European Commission in its 5th Framework Programme (#QLG1-CT-2002-01632 EuroTwin2Twin). Reprints not available from the authors. |
Vol 194 - N° 3
P. 790-795 - mars 2006 Retour au numéro
Article précédent
- Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies
- Liesbeth Lewi, Eduardo Gratacos, Els Ortibus, Dominique Van Schoubroeck, Elena Carreras, Teresa Higueras, Josep Perapoch, Jan Deprest
- Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome
- Romaine Robyr, Liesbeth Lewi, Laurent J. Salomon, Masami Yamamoto, Jean-Pierre Bernard, Jan Deprest, Yves Ville
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?