Placenta - Twin-twin transfusion

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Placenta

Placental findings in specific newborn/fetal or maternal conditions

Twin-twin transfusion

Reviewers: Mandolin Ziadie, M.D. (see Reviewers page)
Revised: 27 January 2013, last major update November 2011
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Definition
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● Unbalanced flow of blood through arteriovenous anastomoses with worse clinical outcome if AV anastomoses without arterioarterial or venovenous anastomoses
● Results in growth discrepancy and mortality, which is usually marked in second trimester
● Both twins are at risk (70% mortality)
● After death of donor twin, may get an acute reverse transfusion

Case reports
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● 22 year old pregnant woman with twins, one with oligohydramnios, one with polyhydramnios (Case of Week #264)

Treatment
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● Serial amniocentesis; removal of a fetus
● Surgical interruption of common vasculature

Gross description
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● Donor twin is anemic, small and pale with small organs
● Recipient twin is large and plethoric with large organs; at risk for high-output cardiac failure

Gross images
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Twin-twin transfusion

Anastomosis

Micro description
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● Donor placentas have large edematous villi, small capillaries and numerous nucleated red blood cells
● Recipient placenta has small, firm and mature villi with congested vessels

End of Placenta > Placental findings in specific newborn/fetal or maternal conditions > Twin-twin transfusion

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