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Placental share and hemoglobin level in relation to birth weight in twin anemia-polycythemia sequence. 2014

D Zhao, and F Slaghekke, and J M Middeldorp, and T Duan, and D Oepkes, and E Lopriore
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: d.zhao@lumc.nl.

BACKGROUND Twin anemia-polycythemia sequence (TAPS) is a newly described form of chronic twin transfusion. Previous observational studies noted a discordance between birth weight and individual placental share in TAPS. The purpose of this study was to investigate if fetal growth in monochorionic (MC) twins with TAPS is determined by placental share or by the net inter-twin blood transfusion. METHODS All consecutive MC twin placentas of live-born twin pairs with and without TAPS examined at our center between June 2002 and February 2014 were included in this study. Hemoglobin (Hb) levels and individual placental share were evaluated at birth and correlated with birth weight share. We excluded MC twin pregnancies with twin-twin transfusion syndrome. RESULTS A total of 270 MC twin pregnancies (TAPS group, n = 20; control group without TAPS, n = 250) were included in this study. Donors with TAPS had a lower birth weight than recipients in 90% (18/20) of cases, but a larger placental share in 65% (13/20) of cases. In the TAPS group, birth weight share was positively correlated with Hb share at birth (P < 0.01) but not with placental share (P = 0.54). In the control group without TAPS, birth weight share was strongly correlated with placental share (P < 0.01) but not with Hb share (P = 0.14). CONCLUSIONS A relatively larger placental share may enable the survival of the anemic twin in TAPS. CONCLUSIONS In contrast with uncomplicated MC twins, fetal growth in MC twins with TAPS is determined primarily by the net inter-twin blood transfusion instead of placental share.

UI MeSH Term Description Entries
D008297 Male Males
D010920 Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (CHORIONIC VILLI) derived from TROPHOBLASTS and a maternal portion (DECIDUA) derived from the uterine ENDOMETRIUM. The placenta produces an array of steroid, protein and peptide hormones (PLACENTAL HORMONES). Placentoma, Normal,Placentome,Placentas,Placentomes
D011086 Polycythemia An increase in the total red cell mass of the blood. (Dorland, 27th ed) Erythrocytosis,Erythrocytoses,Polycythemias
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D001724 Birth Weight The mass or quantity of heaviness of an individual at BIRTH. It is expressed by units of pounds or kilograms. Birthweight,Birth Weights,Birthweights,Weight, Birth,Weights, Birth
D005260 Female Females
D005330 Fetofetal Transfusion Passage of blood from one fetus to another via an arteriovenous communication or other shunt, in a monozygotic twin pregnancy. It results in anemia in one twin and polycythemia in the other. (Lee et al., Wintrobe's Clinical Hematology, 9th ed, p737-8) Cross-Transfusion, Intrauterine,Intrauterine Cross-Transfusion,Twin Transfusion,Twin Transfusion Syndrome,Twin-to-Twin Transfusion,Fetal Transfusion Syndrome,Fetofetal Transfusion Syndrome,Twin Twin Transfusion Syndrome,Twin-to-Twin Transfusion Syndrome,Cross Transfusion, Intrauterine,Fetal Transfusion Syndromes,Fetofetal Transfusion Syndromes,Fetofetal Transfusions,Intrauterine Cross Transfusion,Intrauterine Cross-Transfusions,Syndrome, Fetal Transfusion,Syndrome, Fetofetal Transfusion,Syndrome, Twin Transfusion,Syndrome, Twin-to-Twin Transfusion,Transfusion Syndrome, Fetal,Transfusion Syndrome, Fetofetal,Transfusion Syndrome, Twin,Transfusion Syndrome, Twin-to-Twin,Transfusion, Fetofetal,Transfusion, Twin,Transfusion, Twin-to-Twin,Twin Transfusion Syndromes,Twin Transfusions,Twin to Twin Transfusion,Twin to Twin Transfusion Syndrome,Twin-to-Twin Transfusion Syndromes,Twin-to-Twin Transfusions
D006454 Hemoglobins The oxygen-carrying proteins of ERYTHROCYTES. They are found in all vertebrates and some invertebrates. The number of globin subunits in the hemoglobin quaternary structure differs between species. Structures range from monomeric to a variety of multimeric arrangements. Eryhem,Ferrous Hemoglobin,Hemoglobin,Hemoglobin, Ferrous
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000740 Anemia A reduction in the number of circulating ERYTHROCYTES or in the quantity of HEMOGLOBIN. Anemias

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