Outcome of monochorionic twins with prenatally diagnosed bipartite placenta
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Outcome of monochorionic twins with prenatally diagnosed bipartite placenta Adeline Walter1 · Brigitte Strizek1 · Christoph Berg1,2 · Annegret Geipel1 · Ulrich Gembruch1 · Alexander C. Engels1 Received: 26 August 2019 / Accepted: 25 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose The objective of this study was to identify possible implications and risk factors in monochorionic (MC) twin pregnancies having a bipartite placenta. Materials 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. Results 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%. Conclusion 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.
Introduction The placental structure of twin pregnancies can be monochorionic or dichorionic [1]. Knowing that monochorionic twin pregnancies have an increased risk of adverse perinatal outcomes compared to those with dichorionic pregnancies, correct diagnosis of chorionicity is of utter most clinical importance [2–4]. For determining chorionicity, sonographically detected number of placental masses can be used, although in some cases, the presence of two placenta lobes can mask a bipartite placenta [5, 6]. A monochorionic twin pregnancy might then be declared as dichorionic and potential risk factors are left out of consideration.
* Alexander C. Engels [email protected] 1
Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg‑Campus 1, 53127 Bonn, Germany
Department of Obstetrics and Prenatal Medicine, University Hospital Cologne, Kerpener Straße 34, 50931 Cologne, Germany
2
At present, there is little knowledge about bipartite placenta in monochorionic twin pregnancies with only five published cases so far [6, 7]. We, therefore, conducted a retrospective analysis of prenatally diagnosed cases of bipartite placenta in monochorionic twins to get a profound understanding of this placental malformation, to achieve a better prenatal management and to provide a well-informed consultation in such cases.
Materials and methods Between 2
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