Features of placental angioarchitectonics with favorable and unfavorable outcome after laser coagulation of placental anastomoses

Background. One of the most common and severe complications of monochorionic pregnancy is feto-fetal transfusion syndrome (FFTS). The incidence of transfusion syndrome in monochorial diamniotic twins ranges from 10 to 15%.

Objective. To analyze the angioarchitecture of the placenta in FFTS, to determine its features with a favorable and unfavorable outcome after laser coagulation of placental anastomoses (LPCA).

Materials and methods. Continuous prospective, cohort, comparative study 90 pregnant women with monochorionic diamniotic twins were examined: in 60 people (the main group) the pregnancy was complicated by FFTS, in 30 patients (the comparison group) the pregnancy was characterized by a normal course; their newborns and afterbirths. The main group was divided into 2 subgroups depending on the outcome of LCPA in order to correct FFTS: subgroup 1 — favorable outcome (n=50), subgroup 2 — unfavorable outcome (n=10).

Result. The angioarchitecture of the placenta in FFTS with a favorable outcome of LCPA is characterized by the presence of large arteriovenous placental anastomoses in combination with “central-central” and “central-marginal” variants of umbilical cord attachment. A larger number of anastomoses is recorded in monochorionic twins with FFTS and vascular patterns with two or more arteriovenous anastomoses (“Type B” and “Type D”), in our study they were more common with an unfavorable outcome of laser coagulation of placental anastomoses (OR = 5.23 (95%CI 2.13;12.8);p<0.001).

Conclusion. Angioarchitectonics of the placenta in feto-fetal transfusion syndrome with a favorable outcome of laser coagulation of placental anastomoses is characterized by the presence of large arteriovenous placental anastomoses in combination with “central-central” and “central-marginal” variants of umbilical cord confluence.

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