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Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
This complication of monochorionic twins leads to an imbalance in blood flow between the two fetuses, as the placenta acts as a site of arteriovenous communication between the two fetal circulations. The pathophysiology is not clearly understood, though it appears to be linked to disturbances in volume with a subsequent increase in central venous pressure [7]. This leads to hypoxia in the donor twin and vascular overload in the recipient twin. In some cases of twin-to-twin transfusion syndrome (TTTS) and TRAP sequence, invasive therapy with fetoscopy and laser coagulation or umbilical cord ligation have been associated in some studies with improved fetal survival (see Chapter 46).
Reproductive system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Figure 8.18d is of a twin pregnancy, seen via a transvaginal scan. These twins are of a monochorionic twin pregnancy, i.e. both embryos are within one gestation sac. A dichorionic twin pregnancy would be seen as two separate gestation sacs, each containing an embryo and yolk sac. It is important to determine the chorionicity, as monochorionic twins have a greater risk of complications throughout the pregnancy [72].
The Prenatal Environment and Birth Complications
Published in Gail S. Anderson, Biological Influences on Criminal Behavior, 2019
Some twin studies have included birth complications as a factor, but can we measure the effect? Could the birth complications have affected one twin more than the other? Also, are birth complications more likely in monozygotic twins than dizygotic twins? Chorionicity refers to the number of placentas. DZ twins each have their own placenta, whereas 70% of MZ twins share a single placenta. Risks are higher for monochorionic twins.76 Studies have shown a significant difference between twin and non-twin behavior problems. A study showed that twins showed small but consistently higher levels of problem behaviors than non-twins and suggested that these results may be the result of perinatal injury, which has a higher incidence in the twin population.78 It could also be the result of the environment in which twins grow up, and the researchers have admitted that they did not take regional differences or method of study into account.
Localized Placental Mesenchymal Dysplasia in Monochorionic Diamniotic Twin Placenta with Beckwith-Wiedemann Syndrome
Published in Fetal and Pediatric Pathology, 2022
Meryem Ilkay Eren Karanis, Ayse Gül Zamani
A 27-year-old G2P1 woman in the 29th week of pregnancy was referred to the obstetrics clinic with high blood pressure and edema. Blood pressure was 150/100 mm Hg. Edema (3+), proteinuria, and hypoalbuminemia were detected and the patient was hospitalized with a diagnosis of preeclampsia. Ultrasonography demonstrated a monochorionic twin placenta with localized multicystic enlargement. Intrauterine growth restriction affected both fetuses, more severe in the fetus on the side corresponding to the multicystic portion of the placenta, with measurements compatible with 23 and 26 weeks of gestation. The β-hCG level was 186,487 mIU/mL (normative data for β-hCG in >25th week of pregnancy: 518–74,719 mIU/mL), AFP was 354 ng/mL (normative data for AFP in 29th week of pregnancy: 136 ± 61 ng/mL) [13, 14]. At 31 weeks, due to preterm labor, monochorionic twins were delivered through cesarean section. Maternal serum β-hCG values declined rapidly after delivery.
Monochorionic Twin Discordance for Horseshoe Lung and Tricuspid Atresia
Published in Fetal and Pediatric Pathology, 2022
Marina Sousa Gomes, José Monterroso, Otília Brandão, Carla Ramalho
Some authors speculate that horseshoe lung can be familial [4, 7]. Familial occurrence of tricuspid atresia has been reported, suggesting an autosomal recessive pattern of inheritance [8]. In this case, the discordance between the monochorionic twins for these anomalies suggests that horseshoe lung and tricuspid atresia may be a result of a postzygotic error, probably a complex interaction between genetic, epigenetic, and placental influences. A discordance between monochorionic twins suggests that a common etiological factor may be responsible for both twinning and these congenital malformations, so-called teratogenicity of the twinning process [9]. Postzygotic events during cell division may lead to an unequal allocation of cell numbers in the monozygotic twins [10]. Other mechanisms are possible. AlRais et al. suggested that discordance for cardiac anomalies such as transposition of the great arteries, tricuspid atresia, and ventricular septal defect may be due to epigenetic influences [11]. This discordance may also be explained by the unequal sharing of venous return from the single placenta in monochorionic twins [12]. Hidaka et al. demonstrated also a significant relationship between the abnormal cord insertion and the congenital heart disease in the monochorionic twins [13], that could be explained by hypoperfusion of abnormal fetus. Abnormal placental hemodynamics may result in the acquisition of valvular disease in one twin with subsequent abnormal cardiac chamber growth, leading to hypoplasia of the entire right or left heart [11]. Probably no single factor could explain all abnormalities seen in this case.
Diagnosis of central nervous system abnormalities: comparison of prenatal neurosonography and foetal magnetic resonance imaging findings
Published in Journal of Obstetrics and Gynaecology, 2022
Sureyya Saridas Demir, Erkan Cagliyan, Fatma Ceren Sarioglu, Handan Guleryuz, Sabahattin Altunyurt
One hundred and sixty-two pregnant women were retrospectively enrolled in the study from Dokuz Eylul University School of Medicine, Department of Obstetrics and Gynaecology, Division of Perinatology Department between January 2008 and January 2019. This study was conducted in accordance with the principles of the Helsinki Declaration and Institutional Ethical Committee which approved this study (Approval no. 5252-GOA; 2020/07-28; the date of issue: 13.04.2020). However, a written informed consent was not obtained from the participants due to retrospective research. Patients who underwent both foetal MRI and USG due to suspicion of CNS abnormalities were retrospectively selected from the hospital information processing system. Inclusion criteria were patients who were diagnosed with isolated CNS abnormalities by neurosonography or who had the suspicion of CNS abnormalities and who were referred for foetal MRI above 18 weeks of pregnancy. Exclusion criteria were history of radiation or any teratogen exposure, monochorionic twin pregnancies, foetal MRI requesting below 18 weeks of pregnancy, and fetuses having anomalies other than CNS abnormalities.