Proximate cord insertion in monochorionic twins with selective fetal growth restriction

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-02-01 DOI:10.1016/j.ajogmf.2024.101598

Jip A. Spekman BSc , Eva Ros BSc , Liesbeth Lewi MD, PhD , Femke Slaghekke MD, PhD , E.J.T. Joanne Verweij MD, PhD , Anne T.R. Noll MD , Jeanine M.M. van Klink PhD , Monique C. Haak MD, PhD , Lotte E. van der Meeren MD, PhD , Sophie G. Groene PhD , Enrico Lopriore MD, PhD

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引用次数: 0

Abstract

Background

Monochorionic (MC) twins share a single placenta which can be unequally shared, leading to selective fetal growth restriction (sFGR). Limited data is available on the prevalence and clinical consequences of proximate cord insertion (PCI) in sFGR pregnancies.

Objective

We aimed to investigate the prevalence of PCI in MC placentas with and without sFGR and per type of sFGR, and study the placental characteristics and perinatal outcome of PCI in sFGR pregnancies.

Study design

In this multicenter retrospective cohort study, we included all consecutive placentas of MC twin pregnancies with and without sFGR evaluated between 2002-2023. We excluded MC twins with twin-twin transfusion syndrome, twin anemia polycythemia sequence and monoamnionicity. Our primary outcome included the prevalence of PCI (distance between cord insertions ≤4 cm) and type of cord insertions categorized as concordant, intermediate or discordant. Secondary outcomes consisted of type and size of placental vascular anastomoses and short-term clinical outcomes including fetal demise and birth weight discordance (BWD).

Results

Of 813 MC placentas, 468 were from uncomplicated twins and 345 from sFGR twins (187 type I, 41 type II and 117 type III sFGR). The prevalence of PCI in uncomplicated versus sFGR placentas was 3.8% (18/468) and 4.6% (16/345), respectively (p=0.58). PCI in sFGR type I, II and III was detected in 0.5% (1/187), 0% (0/41) and 12.8% (15/117), respectively (p<0.0001). The prevalence of discordant cord insertions (velamentous-paracentral) in uncomplicated twin placentas and sFGR placentas was 19.9% (93/468) and 45.5% (157/345), respectively (p<0.0001). Diameter of arterio-arterial (AA) anastomoses in sFGR placentas with and without PCI was 3.0 mm (IQR 2.7-5.0) versus 2.2 mm (IQR 1.4-3.1; p<0.0061). BWD in sFGR twins with PCI was 18.5% (IQR 16.4-21.0) and without PCI was 28.0% (IQR 21.8-35.9; p<0.0001). Fetal demise occurred in 12.5% (2/16) of pregnancies with PCI and 6.1% (20/329) of sFGR pregnancies without PCI (p=0.27).

Conclusion

sFGR type III placentas exhibit a high prevalence of PCI, requiring increased awareness due to the presence of larger AA anastomoses and a potentially higher risk of fetal demise.

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.