Identification of arterio–venous anastomoses in vivo in monochorionic twin pregnancies: preliminary report

Authors

  • M. J. O. Taylor,

    Corresponding author
    1. Centre for Fetal Care, Department of Materno-Fetal Medicine, Queen Charlotte's & Chelsea Hospital, London, UK
    • Centre for Fetal Care, Department of Materno-Fetal Medicine, Imperial College School of Medicine, Queen Charlotte's & Chelsea Hospital, Goldhawk Rd, London W6 OXG, UK
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  • D. Farquharson,

    1. Centre for Fetal Care, Department of Materno-Fetal Medicine, Queen Charlotte's & Chelsea Hospital, London, UK
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  • P. M. Cox,

    1. Department of Perinatal Pathology, Imperial College School of Medicine, Queen Charlotte's & Chelsea Hospital, London, UK
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  • N. M. Fisk

    1. Centre for Fetal Care, Department of Materno-Fetal Medicine, Queen Charlotte's & Chelsea Hospital, London, UK
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Abstract

Objective

To determine whether it is possible to identify in vivo placental arterio–venous anastomoses (AVAs) by color Doppler flow mapping.

Methods

Three monochorionic twin pregnancies (one with and two without twin-to-twin transfusion syndrome) underwent placental mapping by color Doppler ultrasound. Placental vessels along the chorionic plate were recorded together with the direction of blood flow and their location in relation to the cord insertions and to superficial arterio–arterial anastomoses. Suggestive AVAs were mapped topographically and results were compared with the findings of formal postnatal placental injection studies.

Results

An AVA was identified in each of the three cases. Injection studies showed multiple AVAs. Each antenatally identified AVA was confirmed at placental injection study. Their placental location correlated to other landmarks as predicted by ultrasound.

Conclusions

This preliminary report demonstrates that AVAs can be identified using color Doppler ultrasound. This may facilitate planning for highly selective ablation of AVAs, and shorter procedure times. Formal studies are now indicated to determine the accuracy of this technique. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

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