Outcome of monochorionic twins with prenatally diagnosed bipartite placenta

  • Adeline Walter
  • Brigitte Strizek
  • Christoph Berg
  • Annegret Geipel
  • Ulrich Gembruch
  • Alexander C. EngelsEmail author



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.

Author contribution

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.

Informed consent

All patients have given written informed consent to data collection, analysis and the use of these data for research.

Ethical approval

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.


  1. 1.
    Fox TB (2006) Multiple pregnancies: determining chorionicity and amnionicity. J Diagn Med Sonogr 22(1):59–65CrossRefGoogle Scholar
  2. 2.
    Benirschke K (2013) Monozygotic twinning. Surg Pathol Clin März 6(1):27–32CrossRefGoogle Scholar
  3. 3.
    Machin GA (2004) Why is it important to diagnose chorionicity and how do we do it? Best Pract Res Clin Obstet Gynaecol 18(4):515–530CrossRefGoogle Scholar
  4. 4.
    Denbow ML, Cox P, Taylor M, Hammal DM, Fisk NM (2000) Placental angioarchitecture in monochorionic twin pregnancies: Relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol 182(2):417–426CrossRefGoogle Scholar
  5. 5.
    Sepulveda W (1997) Chorionicity determination in twin pregnancies: double trouble? Ultrasound Obstet Gynecol 10(2):79–81CrossRefGoogle Scholar
  6. 6.
    Lopriore E, Sueters M, Middeldorp JM, Klumper F, Oepkes D, Vandenbussche FPHA (2006) Twin pregnancies with two separate placental masses can still be monochorionic and have vascular anastomoses. Am J Obstet Gynecol 194(3):804–808CrossRefGoogle Scholar
  7. 7.
    Kim K, Lage JM (1991) Bipartite diamnionic monochorionic twin placenta with superficial vascular anastomoses: report of a case. Hum Pathol 22(5):501–503CrossRefGoogle Scholar
  8. 8.
    Groene SG, Tollenaar LSA, Slaghekke F, Middeldorp JM, Haak M, Oepkes D (2018) Placental characteristics in monochorionic twins with selective intrauterine growth restriction in relation to the umbilical artery Doppler classification. Placenta 71:1–5CrossRefGoogle Scholar
  9. 9.
    Le Lous M, Mediouni I, Chalouhi G, Salomon LJ, Bussières L, Carrier A (2018) Impact of laser therapy for twin-to-twin transfusion syndrome on subsequent pregnancy. Prenat Diagn 38(4):293–297CrossRefGoogle Scholar
  10. 10.
    Lu J, Cheng YKY, Ting YH, Law KM, Leung TY (2018) Pitfalls in assessing chorioamnionicity: novel observations and literature review. Am J Obstet Gynecol 219(3):242–254CrossRefGoogle Scholar
  11. 11.
    Benirschke K, Masliah E (2001) The placenta in multiple pregnancy: outstanding issues. Reprod Fertil Dev 13(7–8):615–622CrossRefGoogle Scholar
  12. 12.
    Fujikura T, Benson RC, Driscoll SG (1970) The bipartite placenta and its clinical features. Am J Obstet Gynecol 107(7):1013–1017CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Prenatal MedicineUniversity Hospital BonnBonnGermany
  2. 2.Department of Obstetrics and Prenatal MedicineUniversity Hospital CologneCologneGermany

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