Hum Reprod. 1999 Aug;14(8):2124-30.
Outcome of twin pregnancies complicated by single intrauterine death in relation
to vascular anatomy of the monochorionic placenta.
Bajoria R, Wee LY, Anwar S, Ward S.
University of Manchester, St Mary's Hospital, Department of Obstetrics &
Gynaecology, Whitworth Park, Manchester M13 OJH, UK.
The objective of this study was to determine the relationship between the type
of placentation, vascular anatomy of the monochorionic (MC) placenta and the
perinatal outcome of the surviving twin following a single intrauterine fetal
death (IUFD). In this retrospective study, 92 twin pregnancies complicated by a
single intrauterine death were identified from three tertiary referral centres
[50 MC and 42 dichorionic (DC)]. Antenatal and neonatal data as well as
information on the chorionicity, vascular anastomoses, and autopsy findings were
also obtained. The percentage risk of IUFD (26 versus 2.4; P < 0.001), anaemia
(51.4 versus 0; P < 0.001) and intracranial lesions at birth (46 versus 0; P <
0.001) was greater in MC than in DC twins. In MC twins without twin-twin
transfusion syndrome (TTTS), perinatal mortality was higher in the group with
superficial arterioarterial (AA)/venovenous (VV) channels than those with only
multiple bidirectional arteriovenous (AV) anastomoses (12/15 versus 0/8; P <
0.001). However, in the TTTS pregnancies (n = 26), perinatal outcome of the
surviving twin was dependent on whether the recipient (n = 16) or the donor twin
(n = 10) died first. Incidence of IUFD (9/16 versus 0/10; P < 0.001), severe
anaemia (7/7 versus 1/10; P < 0.001) and intracranial lesions at birth (6/7
versus 2/10; P < 0.001) was common in pregnancies where the recipient twin died
first. In the TTTS group, unidirectional AV anastomotic channels were found in
all but two placentae. In conclusion, this study suggests that the outcome of
twin pregnancies complicated by IUFD is dependent on the type of vascular
anastomoses and TTTS.
