Outcome of monochorionic twins with prenatally diagnosed bipartite placenta
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The objective of this study was to identify possible implications and risk factors in monochorionic (MC) twin pregnancies having a bipartite placenta.
Between 2014 and 2019 data on such pregnancies was prospectively collected and retrospectively analyzed. Monochorionicity was confirmed either by the presence of a T-sign, one chorion and two separate amnion cavities, or by histological examination postnatally. Bipartite placenta was diagnosed when two placenta lobes were identified with no placental connection between them. Risks of bipartite placenta in MCDA twins were evaluated by background data, prenatal and postnatal outcome.
Five twin pregnancies were included in the study. 60 % (n = 3) were complicated by twin-twin-transfusion syndrome (TTTS), 20 % by selective intrauterine growth restriction (sIUGR) (n = 1) and 20 % (n = 1) by severe fetal malformations. In every case an intervention was indicated, but in only 60% (n = 3) possible, due to poor surgical conditions. Overall fetal survival rate at birth was 90 %. Neonatal survival rate was 66.63%.
Bipartite placenta is a very rare phenomenon in MCDA twin pregnancies. It seems to be associated with a higher rate of complications, such as TTTS and sIUGR and might induce surgical difficulties in prenatal interventions.
We thank our colleagues from BCNatal-Barcelona Center for Maternal–Fetal and Neonatal Medicine (Universidad de Barcelona) for kindly providing information on case 4. We also thank our colleagues from hospital Düren (St. Marien Hospital Düren) for providing postnatal images of case 2, as well as our colleagues from hospital Duisburg (Sana Kliniken Duisburg) for the communication of the maternal and fetal outcome of case 1.
AW, ACE, BS, and CB were involved in data collection and data analaysis. AW, ACE, UG and AG were involved in the study design. AW and ACE created the figures and tables. All the authors contributed in writing and editing of the manuscript.
No funding was received or used for this research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human rights and animal participants
This research includes the data of human participants only.
All patients have given written informed consent to data collection, analysis and the use of these data for research.
Ethical approval was not required as the Ethics Committee of the University of Bonn does not request formal approval for an anonymized retrospective analysis of clinical data, as long as patients have given their written consent.