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Prenatal diagnosis of spontaneous twin anemia-polycythemia sequence and postnatal examination of placental vascular anastomoses

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ABSTRACT

Twin anemia-polycythemia sequence (TAPS) is characterized by a wide discrepancy of hemoglobin between two monochorionic fetuses without sign of twin oligo-polyhydramnios sequence. A primiparous woman with monochorionic diamniotic twin transferred for preterm labor. Ultrasonographic evaluation at 32+3 weeks of gestation revealed increased middle cerebral artery-peak systolic velocity (77.4 cm/sec, 1.69 multiples of median) in donor and decreased in recipient twin (36.4 cm/sec, 0.79 multiples of median), the twin was diagnosed with TAPS. Repeated cesarean section was performed at 32+5 weeks of gestation following preeclampsia and preterm labor. After delivery, TAPS was confirmed through neonatal hematologic examination. There were no signs of acute hemorrhagic shock or brain injury. Placental evaluation via dye infusion and barium angiogram revealed one arterioarterial anastomoses with six arteriovenous anastomoses of placenta. We report a prenatally diagnosed case of spontaneous TAPS with arterioarterial and arteriovenous anastomoses and suggest careful monitoring of monochorionic twin and opinion on placenta vascular architecture.

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Colored dye injection study revealed seven minuscule anastomoses; three non-patent arteriovenous anastomoses (open arrows), three hardly passed arteriovenous anastomoses (arrow heads) and one arterioarterial anastomoses (arrow) (A). Details of arterioarterial anastomoses (B). R, recipient; D, donor.
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Figure 2: Colored dye injection study revealed seven minuscule anastomoses; three non-patent arteriovenous anastomoses (open arrows), three hardly passed arteriovenous anastomoses (arrow heads) and one arterioarterial anastomoses (arrow) (A). Details of arterioarterial anastomoses (B). R, recipient; D, donor.

Mentions: Macroscopic placental examination showed monochorionic diamniotic placenta with a marginal insertion of the umbilical cord of donor and velamentous insertion of the recipient cord. The donor placenta was pale, recipient placenta was reddish congested. Colored agents were added to barium sulphate for achieving accurate visualization of peripheral branches. The arteries and veins of each placenta were injected successively with a 10 mL syringe. After injection, the cords were clamped again to maintain filling of the vessel. Dye injection study revealed seven minuscule anastomoses; six arteriovenous (AV) anastomoses and one AA anastomoses from donor to recipient (Fig. 2). Colored dye did not pass throughout the three AV anastomoses and passed hardly with squeezing and multiple forced injection in the three AV anastomoses. In AA anastomoses colored dye passed easily without resistance, suggestive to in-utero patency. Therefore we suggest that the AA anastomoses caused TAPS development in spite of presence of AV anastomoses. Single-shot digital x-ray barium angiography revealed wider placenta territory of donor twin (donor to recipient ratio, 65:35).


Prenatal diagnosis of spontaneous twin anemia-polycythemia sequence and postnatal examination of placental vascular anastomoses
Colored dye injection study revealed seven minuscule anastomoses; three non-patent arteriovenous anastomoses (open arrows), three hardly passed arteriovenous anastomoses (arrow heads) and one arterioarterial anastomoses (arrow) (A). Details of arterioarterial anastomoses (B). R, recipient; D, donor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120076&req=5

Figure 2: Colored dye injection study revealed seven minuscule anastomoses; three non-patent arteriovenous anastomoses (open arrows), three hardly passed arteriovenous anastomoses (arrow heads) and one arterioarterial anastomoses (arrow) (A). Details of arterioarterial anastomoses (B). R, recipient; D, donor.
Mentions: Macroscopic placental examination showed monochorionic diamniotic placenta with a marginal insertion of the umbilical cord of donor and velamentous insertion of the recipient cord. The donor placenta was pale, recipient placenta was reddish congested. Colored agents were added to barium sulphate for achieving accurate visualization of peripheral branches. The arteries and veins of each placenta were injected successively with a 10 mL syringe. After injection, the cords were clamped again to maintain filling of the vessel. Dye injection study revealed seven minuscule anastomoses; six arteriovenous (AV) anastomoses and one AA anastomoses from donor to recipient (Fig. 2). Colored dye did not pass throughout the three AV anastomoses and passed hardly with squeezing and multiple forced injection in the three AV anastomoses. In AA anastomoses colored dye passed easily without resistance, suggestive to in-utero patency. Therefore we suggest that the AA anastomoses caused TAPS development in spite of presence of AV anastomoses. Single-shot digital x-ray barium angiography revealed wider placenta territory of donor twin (donor to recipient ratio, 65:35).

View Article: PubMed Central - PubMed

ABSTRACT

Twin anemia-polycythemia sequence (TAPS) is characterized by a wide discrepancy of hemoglobin between two monochorionic fetuses without sign of twin oligo-polyhydramnios sequence. A primiparous woman with monochorionic diamniotic twin transferred for preterm labor. Ultrasonographic evaluation at 32+3 weeks of gestation revealed increased middle cerebral artery-peak systolic velocity (77.4 cm/sec, 1.69 multiples of median) in donor and decreased in recipient twin (36.4 cm/sec, 0.79 multiples of median), the twin was diagnosed with TAPS. Repeated cesarean section was performed at 32+5 weeks of gestation following preeclampsia and preterm labor. After delivery, TAPS was confirmed through neonatal hematologic examination. There were no signs of acute hemorrhagic shock or brain injury. Placental evaluation via dye infusion and barium angiogram revealed one arterioarterial anastomoses with six arteriovenous anastomoses of placenta. We report a prenatally diagnosed case of spontaneous TAPS with arterioarterial and arteriovenous anastomoses and suggest careful monitoring of monochorionic twin and opinion on placenta vascular architecture.

No MeSH data available.


Related in: MedlinePlus