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Pathology of Twinning

  • Geoffrey A. Machin

Abstract

The frequency of perinatal mortality and morbidity in Western countries has begun to stabilize, so that the remaining causes are clearly difficult to reduce. Among these causes is twinning; in relation to the frequency of twin birth (about 1 in 55 deliveries), twin are over-represented ten times as causes of perinatal and mortality and morbidity. Clearly, being one of twins is not incidental to the cause of any adverse outcome, but is probably a primary factor. All twins are at risk of invoking preterm labour, preterm ruptured membranes, pregnancy-associated hypertension and antepartum haemorrhage as “background” causes of increased rates of complications; but it is the subgroup of twins with monochorionic (MC) placentae who suffer particularly high rates of mortality and morbidity, directly related to placentation. Therefore, all investigations of adverse outcomes in multifetal pregnancy need to take account of placental anatomy; and in turn, placental anatomy is related to zygosity.

Keywords

Chorionic Plate Cord Insertion Twin Reverse Arterial Perfusion Acardiac Twin Multifetal Pregnancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Achiron R, Rosen N, Zakut H (1987) Pathophysiologic mechanism of hydramnios development in twin transfusion syndrome. A case report. J Reprod Med 32:305–308PubMedGoogle Scholar
  2. Bajoria R, Wigglesworth J, Fisk NK (1995) Angioarchitecture of monochorionic placentae in relation to the twin-twin transfusion syndrome. Am J Obstet Gynecol 172: 856–863PubMedCrossRefGoogle Scholar
  3. Benirschke K (1992) The contribution of placental anastomoses to prenatal twin damage. Hum Pathol 12:1319–1320CrossRefGoogle Scholar
  4. Danskin FH, Nielson JP (1989) Twin-to-twin transfusion syndrome: what are appropriate diagnostic criteria? Am J Obstet Gynecol 161:365–369PubMedGoogle Scholar
  5. De Lia JE, Cruickshank DP, Keye WR (1990) Fetoscopic neobdynium: YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome. Obstet Gynecol 75:1046–1053PubMedGoogle Scholar
  6. Derom C (1996) personal communicationGoogle Scholar
  7. Derom C, Vlietinck R, Derom R, Van den Bergh H, Thiery M (1987) Increased monozygotic twinning rate after ovulation induction. Lancet i: 1236–1238CrossRefGoogle Scholar
  8. Fisk NM, Borrell A, Hubinont C et al. (1990) Fetofetal transfusion syndrome: do the neonatal criteria apply in utero? Arch Dis Child 65:657–661PubMedCrossRefGoogle Scholar
  9. Fries MH, Goldstein RB, Kilpatrick SJ et al. (1993) The role of velamentous cord insertion in the aetiology of twin-twin transfusion syndrome. Obstet Gynecol 81:569–574PubMedGoogle Scholar
  10. Golbus MS, Cunningham N, Goldberg JD et al. (1988) Selective termination of multiple gestation. Am J Med Genet 31:339–438PubMedCrossRefGoogle Scholar
  11. Heydanus R, Santema JG, Stewart PA et al. (1993) Preterm delivery rate and fetal outcome in structurally affected twin pregnancies: a retrospective matched controlled study. Prenat Diagn 13:155–162PubMedCrossRefGoogle Scholar
  12. Machin GA (1993) Conjoined twins: Implications for blastogen-esis. In: Opitz JM, Paul NW (eds) Blastogenesis normal and abnormal. March of Dimes Birth Defects Foundation. Birth defects: original article series 29:141–179Google Scholar
  13. Machin GA (1996) Some causes of gentotypic and phenotypic discordance in monozygotic twin pairs. Am J Med Genet 61: 216–228PubMedCrossRefGoogle Scholar
  14. Machin GA (1997) Velamentous cord insertion is an added risk factor in monochorionic twin gestations. J Reprod Med 42:785–789PubMedGoogle Scholar
  15. Machin GA, Bamforth F (1996) Zygosity and placental anatomy in 15 consecutive sets of spontaneously conceived triplets. Am J Med Genet 61:247–252PubMedCrossRefGoogle Scholar
  16. Machin GA, Still K, Lalani T (1996) Correlations of placental vascular anatomy and clinical outcomes in 69 monochorionic twin pregnancies. Am J Med Genet 61:229–236PubMedCrossRefGoogle Scholar
  17. Mahony BS, Petty CN, Nyberg DA et al. (1990) The “stuck twin” phenomenon: Ultrasonographic findings, pregnancy outcome, and management with serial amniocentesis. Am J Obstet Gynecol 163:1513–1522PubMedGoogle Scholar
  18. Meagher S, Tippett C, Renou P, Baker L, Susil B (1995) Twin-twin transfusion: Intra-amniotic pressure measurement in the assessment of volume reduction at serial amniocentesis. Aust NZ J Obstet Gynaecol 35:22–26CrossRefGoogle Scholar
  19. Patten RM, Mack LA, Harvey D, Cyr DR, Pretorius DH (1989) Disparity of amniotic fluid volume and fetal size: problem of the stuck twin — US studies. Radiology 172:153–157Google Scholar
  20. Pinette MG, Pan Y, Pinette SG, Stubblefield PG (1993) Treatment of twin-twin transfusion syndrome. Obstet Gynecol 82:841–846PubMedGoogle Scholar
  21. Reisner DP, Mahony BS, Petty CN et al. (1993) Stuck twin syndrome: outcome in thirty-seven consecutive cases. Am J Obstet Gynecol 169:991–999PubMedGoogle Scholar
  22. Rosen DJD, Rabinowitz R, Beyeth Y, Fejgin MD, Nicolaides KH (1990) Fetal urine production in normal twins and in twins with acute polyhydramnios. Fetal Diagn Ther 5:57–60PubMedCrossRefGoogle Scholar
  23. Saunders NJ, Snijders RJ, Nicolaides KH (1990) Therapeutic amniocentesis in twin-twin transfusion syndrome appearing in the second trimester of pregnancy. Am Obstet Gynecol 166:820–825Google Scholar
  24. Spencer R (1992) Conjoined twins: theoretical embryologic basis. Teratology 29:591–602CrossRefGoogle Scholar
  25. Tessen JA, Zlatnik FJ (1991) Monoamniotic twinning: a retrospective controlled study. Obstet Gynecol 77:832–834PubMedGoogle Scholar
  26. Vayssiere CF, Heim N, Camus EP, Hillion YE, Nisand IF (1996) Determination of chorionicity in twin gestations by high-frequency abdominal ultrasonography: counting the layers of the dividing membrane. Am J Obstet Gynecol 175:1529–1533PubMedCrossRefGoogle Scholar
  27. Ville Y, Hyett J, Hecher K, Nicolaides K (1995) Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med 332:224–227PubMedCrossRefGoogle Scholar
  28. Ville Y, Sideris I, Nicolaides KH (1996) Amniotic fluid pressure in twin-twin transfusion syndrome: an objective prognostic factor. Fetal Diagn Ther 11:176–180PubMedCrossRefGoogle Scholar
  29. Wolf HK, MacDonald J, Bradford WB, Lanman JT (1991) Acardius anceps with evidence of intrauterine vascular occlusion: Report of a case and discussion of the pathogenesis. Pediatr Pathol 11:143–152PubMedCrossRefGoogle Scholar
  30. Yoshida K, Soma H (1986) Outcome of the surviving cotwin of a fetus papyraceus or of a dead twin fetus. Acta Genet Med Gemellol 35:91–98PubMedGoogle Scholar

General Reading

  1. Baldwin VJ (1994) Pathology of multiple pregnancy. Springer-Verlag, New YorkCrossRefGoogle Scholar
  2. Benirschke K, Kaufmann P (1995) Pathology of the human placenta, 3rd edn. Springer-Verlag, New YorkGoogle Scholar
  3. Machin GA, Keith LG (1999) Biology and pathology of twins. An atlas. Parthenon Press. New York, London.Google Scholar

Copyright information

© Springer-Verlag London 2001

Authors and Affiliations

  • Geoffrey A. Machin

There are no affiliations available

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