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Die Plazenta bei Zwillingen

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Die Plazenta

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Zusammenfassen

Das Management einer Zwillingsschwangerschaft beginnt mit der korrekten Beurteilung der Chorion- und Amnionverhältnisse bereits beim Ultraschall im ersten Trimester. Es gibt zahlreiche Unterschiede zwischen Einlings- und Zwillingsplazenten. Während dichoriale Plazenten denen von Einlingen ähneln können, unterscheiden sich monochoriale Plazenten davon grundsätzlich. Das Verständnis der Architektur von Zwillingsplazenten ist entscheidend, um den Mechanismen der Pathologien zu verstehen. In diesem Kapitel werden die Unterschiede zwischen monochorialen und dichorialen Plazenten näher erläutert. Weiterhin wird die Bedeutung und Pathologie der Plazenta beim Zwillingstransfusionssyndrom und beim diskordanten Zwillingswachstum erläutert.

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Literatur

  • Almog B et al (2002) Placental apoptosis in discordant twins. Placenta 23(4):331–336

    Article  CAS  Google Scholar 

  • Bajoria R, Ward S, Chatterjee R (2003) Brain natriuretic peptide and endothelin-1 in the pathogenesis of polyhydramnios-oligohydramnios in monochorionic twins. Am J Obstet Gynecol 189(1):189–194

    Article  CAS  Google Scholar 

  • Blumenfeld YJ et al (2014) Accuracy of sonographic chorionicity classification in twin gestations. J Ultrasound Med 33(12):2187–2192

    Article  Google Scholar 

  • Chalouhi GE et al (2013) Active management of selective intrauterine growth restriction with abnormal Doppler in monochorionic diamniotic twin pregnancies diagnosed in the second trimester of pregnancy. Prenat Diagn 33(2):109–115

    Article  CAS  Google Scholar 

  • Chan MP, Hecht JL, Kane SE (2010) Incidence and clinicopathologic correlation of fetal vessel thrombosis in mono- and dichorionic twin placentas. J Perinatol 30(10):660–664

    Article  CAS  Google Scholar 

  • Chmait RH, Kontopoulos EV, Quintero RA (2014) Sequential laser surgery for twin-twin transfusion syndrome. Am J Perinatol 31(Suppl 1):S13–18

    PubMed  Google Scholar 

  • Costa-Castro T et al (2013) Velamentous cord insertion in monochorionic twins with or without twin-twin transfusion syndrome: does it matter? Placenta 34(11):1053–1058

    Article  CAS  Google Scholar 

  • Costa-Castro T et al (2016) Velamentous cord insertion in dichorionic and monochorionic twin pregnancies – does it make a difference? Placenta 42:87–92

    Article  CAS  Google Scholar 

  • Couck I et al (2017a) Does the site of the cord insertion increase the risk of adverse outcome, twin-to-twin transfusion syndrome and discordant growth in monochorionic twin pregnancies? Ultrasound Obstet Gynecol https://doi.org/10.1002/uog.18926 (Epub ahead of print)

  • Couck I et al. (2017b) How best to define selective intrauterine growth restriction in monochorionic twin pregnancies? (unveröffentlichte Daten, eingereicht zur Publikation)

    Google Scholar 

  • Couck I, Lewi L (2016) The placenta in twin-to-twin transfusion syndrome and twin anemia polycythemia sequence. Twin Res Hum Genet 19(3):184–190

    Article  Google Scholar 

  • De Paepe ME et al (2010a) Placental markers of twin-to-twin transfusion syndrome in diamniotic-monochorionic twins: a morphometric analysis of deep artery-to-vein anastomoses. Placenta 31(4):269–276

    Article  Google Scholar 

  • De Paepe ME et al (2010b) Placental characteristics of selective birth weight discordance in diamniotic-monochorionic twin gestations. Placenta 31(5):380–386

    Article  Google Scholar 

  • De Paepe ME, De Koninck P, Friedman RM (2005) Vascular distribution patterns in monochorionic twin placentas. Placenta 26(6):471–475

    Article  Google Scholar 

  • Denbow ML et al (2000) Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol 182(2):417–426

    Article  CAS  Google Scholar 

  • Fichera A et al (2005) Antenatal detection of arterio-arterial anastomoses by Doppler placental assessment in monochorionic twin pregnancies. Fetal Diagn Ther 20(6):519–523

    Article  Google Scholar 

  • Fries MH et al (1993) The role of velamentous cord insertion in the etiology of twin-twin transfusion syndrome. Obstet Gynecol 81(4):569–574

    CAS  PubMed  Google Scholar 

  • Galjaard S et al (2014) Partial monochorionic and monoamniotic twin pregnancies: a report of two cases. Ultrasound Obstet Gynecol 44(6):722–724

    Article  CAS  Google Scholar 

  • Gou C et al (2017) Placental characteristics in monochorionic twins with selective intrauterine growth restriction assessed by gradient angiography and three-dimensional reconstruction. J Matern Fetal Neonatal Med 30(21):2590–2595

    Article  Google Scholar 

  • Gratacos E et al (2007) A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 30(1):28–34

    Article  CAS  Google Scholar 

  • Gratacos E et al (2008) Monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic flow (Type III): feasibility and perinatal outcome of fetoscopic placental laser coagulation. Ultrasound Obstet Gynecol 31(6):669–675

    Article  CAS  Google Scholar 

  • Gueneuc A et al (2017) Pitfall in first-trimester diagnosis of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol 49(2):277–278

    Article  CAS  Google Scholar 

  • Hack KE et al (2008) Placental characteristics of monochorionic diamniotic twin pregnancies in relation to perinatal outcome. Placenta 29(11):976–981

    Article  CAS  Google Scholar 

  • Hanley ML et al (2002) Placental cord insertion and birth weight discordancy in twin gestations. Obstet Gynecol 99(3):477–482

    PubMed  Google Scholar 

  • Hecher K et al (1994) Artery-to-artery anastomosis in monochorionic twins. Am J Obstet Gynecol 171(2):570–572

    Article  CAS  Google Scholar 

  • Jauniaux E, Melcer Y, Maymon R (2017) Prenatal diagnosis and management of vasa previa in twin pregnancies: a case series and systematic review. Am J Obstet Gynecol 216(6):568–575

    Article  Google Scholar 

  • Kent EM et al (2011) Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective ESPRiT Study. Am J Obstet Gynecol 205(4):376 e1–7

    Article  Google Scholar 

  • Kent EM et al (2012) Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT Study. Am J Obstet Gynecol 207(3):220 e1–5

    Article  Google Scholar 

  • Khalil A et al (2016) ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 47(2):247–263

    Article  CAS  Google Scholar 

  • Klatt J et al (2012) Single umbilical artery in twin pregnancies. Ultrasound Obstet Gynecol 39(5):505–509

    Article  CAS  Google Scholar 

  • Lewi L et al (2006) Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye? Am J Obstet Gynecol 194(3):790–795

    Article  Google Scholar 

  • Lewi L et al (2007) Placental sharing, birthweight discordance, and vascular anastomoses in monochorionic diamniotic twin placentas. Am J Obstet Gynecol 197(6):587 e1–8

    Google Scholar 

  • Lewi L et al (2008a) The role of ultrasound examination in the first trimester and at 16 weeks’ gestation to predict fetal complications in monochorionic diamniotic twin pregnancies. Am J Obstet Gynecol 199(5):493 e1–7

    Google Scholar 

  • Lewi L et al (2008b) Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth. Am J Obstet Gynecol 199(5):511 e1–7

    Google Scholar 

  • Lewi L et al (2010) Monochorionic diamniotic twin pregnancies: natural history and risk stratification. Fetal Diagn Ther 27(3):121–133

    Article  Google Scholar 

  • Lewi L, Deprest J, Hecher K (2013) The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. Am J Obstet Gynecol 208(1):19–30

    Article  Google Scholar 

  • Linduska N et al (2012) Placental magnetic resonance imaging in monochorionic twin pregnancies. J Matern Fetal Neonatal Med 25(8):1419–1422

    Article  Google Scholar 

  • Lopriore E et al (2007) Velamentous cord insertion and unequal placental territories in monochorionic twins with and without twin-to-twin-transfusion syndrome. Am J Obstet Gynecol 196(2):159 e1–5

    Article  Google Scholar 

  • Machin GA (1997) Velamentous cord insertion in monochorionic twin gestation. An added risk factor. J Reprod Med 42(12):785–789

    CAS  PubMed  Google Scholar 

  • Mahieu-Caputo D et al (2000) Twin-to-twin transfusion syndrome. Role of the fetal renin-angiotensin system. Am J Pathol 156(2):629–636

    Article  CAS  Google Scholar 

  • Murata S et al (2016) Twin-twin transfusion syndrome in a monozygotic pregnancy with obvious lambda sign in first-trimester ultrasound. Taiwan J Obstet Gynecol 55(6):904–906

    Article  Google Scholar 

  • Ortibus E et al (2009) The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol 200(5):494 e1–8

    Article  Google Scholar 

  • Parra-Cordero M et al (2015) Cord occlusion in monochorionic twins with early selective intrauterine growth restriction and abnormal umbilical artery Doppler: a consecutive series of 90 cases. Fetal Diagn Ther 39(3):186–191

    Article  Google Scholar 

  • Saunders NJ, Snijders RJ, Nicolaides KH (1991) Twin-twin transfusion syndrome during the 2nd trimester is associated with small intertwin hemoglobin differences. Fetal Diagn Ther 6(1–2):34–36

    Article  CAS  Google Scholar 

  • Senat MV et al (2004) Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 351(2):136–144

    Article  CAS  Google Scholar 

  • Sherer DM, Sokolovski M, Haratz-Rubinstein N (2002) Diagnosis of umbilical cord entanglement of monoamniotic twins by first-trimester color Doppler imaging. J Ultrasound Med 21(11):1307–1309

    Article  Google Scholar 

  • Slaghekke F et al (2014) Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet 383(9935):2144–2151

    Article  Google Scholar 

  • Stout MJ et al (2013) The incidence of isolated single umbilical artery in twins and adverse pregnancy outcomes. Prenat Diagn 33(3):269–272

    Article  Google Scholar 

  • Sun L et al (2017) Placental up-regulation of leptin and ARMS2 is associated with growth discordance in monochorionic diamniotic twin pregnancies. Twin Res Hum Genet 20(2):169–179

    Article  Google Scholar 

  • Tan TY et al (2004) Occlusion of arterio-arterial anastomosis manifesting as acute twin-twin transfusion syndrome. Placenta 25(2–3):238–242

    Article  CAS  Google Scholar 

  • Umur A et al (2002) Monochorionic twins and twin-twin transfusion syndrome: the protective role of arterio-arterial anastomoses. Placenta 23(2–3):201–209

    Article  CAS  Google Scholar 

  • Umur A, Gemert MJ van, Nikkels PG (2003) Monoamniotic-versus diamniotic-monochorionic twin placentas: anastomoses and twin-twin transfusion syndrome. Am J Obstet Gynecol 189(5):1325–1329

    Article  Google Scholar 

  • Valsky DV et al (2010) Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas. Semin Fetal Neonatal Med 15(6):342–348

    Article  Google Scholar 

  • Van Mieghem T et al (2009) Ultrasound prediction of intertwin birth weight discordance in monochorionic diamniotic twin pregnancies. Prenat Diagn 29(3):240–244

    Article  Google Scholar 

  • Villiers SF de et al (2012) Arterio-arterial vascular anastomoses in monochorionic placentas with and without twin-twin transfusion syndrome. Placenta 33(8):652–654

    Article  Google Scholar 

  • Villiers SF de et al (2015) Correlation between veno-venous anastomoses, TTTS and perinatal mortality in monochorionic twin pregnancies. Placenta 36(5):603–606

    Article  Google Scholar 

  • Walsh CA et al (2015) ‛False’ lambda sign in monochorionic twin pregnancy. Ultrasound Obstet Gynecol 46(3):376–377

    Article  CAS  Google Scholar 

  • Weiner E et al (2017) Nonpresenting Dichorionic Twins and Placental Vascular Malperfusion. Obstet Gynecol 129(6):1109–1117

    Article  Google Scholar 

  • Weis MA et al (2012) Natural history of placenta previa in twins. Obstet Gynecol 120(4):753–758

    Article  Google Scholar 

  • Wijngaard JP van den et al (2008) Case report: twin-to-twin transfusion syndrome resulting from placental collateral artery development. Placenta 29(2):220–223

    Article  Google Scholar 

  • Wu J et al (2017) Placental NFE2L2 is discordantly activated in monochorionic twins with selective intrauterine growth restriction and possibly regulated by hypoxia. Free Radic Res 51(4):351–359

    Article  CAS  Google Scholar 

  • Yonetani N et al (2015) Significance of velamentous cord insertion for twin-twin transfusion syndrome. Fetal Diagn Ther 38(4):276–281

    Article  Google Scholar 

  • Zhang GL et al (2015) Discordant HIF1A mRNA levels and oxidative stress in placental shares of monochorionic twins with selective intra-uterine growth restriction. Placenta 36(3):297–303

    Article  Google Scholar 

  • Zhao DP et al (2015a) Monochorionic placentas with proximate umbilical cord insertions: definition, prevalence and angio-architecture. Placenta 36(2):221–225

    Article  CAS  Google Scholar 

  • Zhao DP et al (2015b) Veno-venous anastomoses in twin-twin transfusion syndrome: a multicenter study. Placenta 36(8):911–914

    Article  CAS  Google Scholar 

  • Zhao D et al (2016) Comparison between monochorionic and dichorionic placentas with special attention to vascular anastomoses and placental share. Twin Res Hum Genet 19(3):191–196

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgien

    Isabel Couck & Liesbeth Lewi

  2. Department of Development and Regeneration, KU Leuven, Leuven, Belgien

    Isabel Couck & Liesbeth Lewi

  3. Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Anke Diemert & Kurt Hecher

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  1. Isabel Couck
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  2. Anke Diemert
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  3. Kurt Hecher
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  4. Liesbeth Lewi
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Correspondence to Isabel Couck .

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Editors and Affiliations

  1. Ordinarius, Lehrstuhl für Zellbiologie Histologie und Embryologie, Gottfried Schatz Forschungszentrum, Medizinische Universität Graz, Graz, Austria

    Berthold Huppertz

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Jena, Jena, Germany

    Ekkehard Schleußner

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Couck, I., Diemert, A., Hecher, K., Lewi, L. (2018). Die Plazenta bei Zwillingen. In: Huppertz, B., Schleußner, E. (eds) Die Plazenta. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55622-1_12

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  • DOI: https://doi.org/10.1007/978-3-662-55622-1_12

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