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Chapter 29 - New Frontiers in Multiple Pregnancy Management

Published online by Cambridge University Press:  11 October 2022

By
Caroline J. Shaw  and
Christoph C. Lees
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Multiple pregnancies, especially those involving monochorionic placentation, have increased risks compared to singleton pregnancies. Better understanding of the angioarchitecture and vascular function of monochorionic placentae will help describe the pathophysiology of disease in monochorionic pregnancies. Research in this area will guide risk stratification, non-invasive diagnosis and treatment strategies in MCDA twins, notably in relation to twin-twin transfusion syndrome (TTTS) and selective growth restriction. Here, we describe MRI and ultrasound advances in placental vascular imaging, including blood oxygenation level dependant (BOLD-MRI), low flow Doppler, and the development of high intensity focused ultrasound (HIFU) as a non-invasive treatment for TTTS and twin reversed arterial perfusion (TRAP) sequence in monochorionic twins.

Keywords

Monochorionic twinsmonochorionic placental anastomoseshigh intensity focused ultrasound (HIFU)BOLD-MRIlow flow DopplerTTTSselective growth restriction
Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 318 - 328
Publisher: Cambridge University Press
Print publication year: 2022

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References

Bajoria, R, Wigglesworth, J, Fisk, NM. Angioarchitecture of monochorionic placentas in relation to the twin–twin transfusion syndrome. Am J Obstet Gynecol 1995;172(3):856–63.CrossRefGoogle Scholar
Roberts, D, Neilson, JP, Kilby, MD, Gates, S. Interventions for the treatment of twin–twin transfusion syndrome. Cochrane Database Syst Rev 2014;1:CD002073.Google Scholar
Grigsby, PL. Animal models to study placental development and function throughout normal and dysfunctional human pregnancy. Semin Reprod Med 2016;34(1):11–16.Google ScholarPubMed
Kaiser, J. Reproductive biology. Gearing up for a closer look at the human placenta. Science 2014;344(6188):1073.CrossRefGoogle Scholar
Taylor, MJ, Denbow, ML, Tanawattanacharoen, S, Gannon, C, Cox, PM, Fisk, NM. Doppler detection of arterio-arterial anastomoses in monochorionic twins: feasibility and clinical application. Hum Reprod 2000;15(7):1632–6.Google Scholar
Machin, GA, Feldstein, VA, Van Gemert, MJ, Keith, LG, Hecher, K. Doppler sonographic demonstration of arterio-venous anastomosis in monochorionic twin gestation. Ultrasound Obstet Gynecol 2000;16(3):214–17.CrossRefGoogle ScholarPubMed
Wee, LY, Sullivan, M, Humphries, K, Fisk, NM. Longitudinal blood flow in shared (arteriovenous anastomoses) and non-shared cotyledons in monochorionic placentae. Placenta 2007;28(5–6):516–22.CrossRefGoogle ScholarPubMed
Sun, W, Cai, A. OP12.03: 3D high-definition flow combined with tomographic ultrasound imaging in observation of placental vascular anastomoses in monochorionic twins. Ultrasound Obstet Gynecol 2019;54(S1):124-.CrossRefGoogle Scholar
Sato, T. Technological description of advanced dynamic flow in the aplio diagnostic ultrasound system. eMedical Review, Toshiba Corporation, 2003.Google Scholar
Mack, LM, Mastrobattista, JM, Gandhi, R, Castro, EC, Burgess, APH, Lee, W. Characterization of placental microvasculature using superb microvascular imaging. J Ultrasound Med 2019;38(9):2485–91.CrossRefGoogle ScholarPubMed
Girardelli, S, Shaw, C, Lees, C. OP12.02: Mapping of the placental angioarchitecture in monochorionic twin pregnancies using different colour Doppler filters. Ultrasound Obstet Gynecol 2019;54(S1):123.CrossRefGoogle Scholar
Nakata, M, Martínez, JM, Díaz, C, Chmait, R, Quintero, RA. Intra-amniotic Doppler measurement of blood flow in placental vascular anastomoses in twin–twin transfusion syndrome. Ultrasound Obstet Gynecol 2004;24(1):102–3.CrossRefGoogle ScholarPubMed
Torrents-Barrena, J, Lopez-Velazco, R, Piella, G et al. TTTS-GPS: patient-specific preoperative planning and simulation platform for twin-to-twin transfusion syndrome fetal surgery. Comput Methods Programs Biomed 2019;179:104993.CrossRefGoogle ScholarPubMed
Werner, H, Dos Santos, JL, Sa, RA et al. Visualisation of the vascular equator in twin-to-twin transfusion syndrome by virtual fetoscopy. Arch Gynecol Obstet 2015;292(6):1183–4.CrossRefGoogle ScholarPubMed
Denbow, ML, Taylor, M, Cox, P, Fisk, NM. Derivation of rate of arterio-arterial anastomotic transfusion between monochorionic twin fetuses by Doppler waveform analysis. Placenta 2004;25(7):664–70.CrossRefGoogle ScholarPubMed
Shapira-Zaltsberg, G, Grynspan, D, Reddy, D, Miller, E. Apparent diffusion coefficient of the placenta in twin versus singleton pregnancies. Fetal Diagn Ther 2018;44(2):129–34.CrossRefGoogle ScholarPubMed
Fu, L, Zhang, J, Xiong, S, Sun, M. Decreased apparent diffusion coefficient in the placentas of monochorionic twins with selective intrauterine growth restriction. Placenta 2018;69:26–31.CrossRefGoogle ScholarPubMed
Poulsen, SS, Sinding, M, Hansen, DN, Peters, DA, Frokjaer, JB, Sorensen, A. Placental T2* estimated by magnetic resonance imaging and fetal weight estimated by ultrasound in the prediction of birthweight differences in dichorionic twin pairs. Placenta 2019;78:18–22.CrossRefGoogle ScholarPubMed
Luo, J, Abaci Turk, E, Bibbo, C et al. In vivo quantification of placental insufficiency by BOLD MRI: a human study. Sci Rep 2017;7(1):3713.CrossRefGoogle ScholarPubMed
Norwitz, ER, McNeill, G, Kalyan, A et al. Validation of a single-nucleotide polymorphism-based non-invasive prenatal test in twin gestations: determination of zygosity, individual fetal sex, and fetal aneuploidy. J Clin Med 2019;8(7).Google Scholar
Chen, J, Chen, W, Zhang, L et al. Safety of ultrasound-guided ultrasound ablation for uterine fibroids and adenomyosis: a review of 9988 cases. Ultrason Sonochem 2015;27:671–6.CrossRefGoogle ScholarPubMed
Seo, K, Ichizuka, K, Okai, T et al. Treatment of twin-reversed arterial perfusion sequence using high-intensity focused ultrasound. Ultrasound Obstet Gynecol 2019 Jul;54(1):128–34.Google Scholar
Shaw, CJ, Ter Haar, GR, Rivens, IH, Giussani, DA, Lees, CC. Pathophysiological mechanisms of high-intensity focused ultrasound-mediated vascular occlusion and relevance to non-invasive fetal surgery. J R Soc Interface 2014;11(95):20140029.CrossRefGoogle ScholarPubMed
Caloone, J, Huissoud, C, Vincenot, J et al. High-intensity focused ultrasound applied to the placenta using a toroidal transducer: a preliminary ex-vivo study. Ultrasound Obstet Gynecol 2015;45(3):313–19.CrossRefGoogle Scholar
Shaw, CJ, Civale, J, Botting, KJ et al. Noninvasive high-intensity focused ultrasound treatment of twin–twin transfusion syndrome: A preliminary in vivo study. Sci Transl Med 2016;8(347):347ra95.CrossRefGoogle ScholarPubMed
Shaw, CJ, Rivens, I, Civale, J et al. Trans-abdominal in vivo placental vessel occlusion using high intensity focused ultrasound. Sci Rep 2018;8(1):13631.Google Scholar
Shaw, CJ, Rivens, I, Civale, J et al. Maternal and fetal cardiometabolic recovery following ultrasound-guided high-intensity focused ultrasound placental vascular occlusion. J R Soc Interface 2019;16(154):20190013.Google Scholar
ISTCRN registry. Developing a non-invasive treatment for twin–twin transfusion syndrome. https://doi.org/10.1186/ISRCTN33458649CrossRefGoogle Scholar
Chmait, RH, Assaf, SA, Benirschke, K. Residual vascular communications in twin–twin transfusion syndrome treated with sequential laser surgery: frequency and clinical implications. Placenta 2010;31(7):611–14.CrossRefGoogle ScholarPubMed
Walsh, CA, McAuliffe, FM. Recurrent twin–twin transfusion syndrome after selective fetoscopic laser photocoagulation: a systematic review of the literature. Ultrasound Obstet Gynecol 2012;40(5):506–12.Google Scholar

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