TY - JOUR
T1 - Why does second trimester demise of a monochorionic twin not result in acardiac twinning?
AU - van Gemert, Martin J. C.
AU - van der Geld, Cees W. M.
AU - Ross, Michael G.
AU - Nikkels, Peter G. J.
AU - van den Wijngaard, Jeroen P. H. M.
N1 - Publisher Copyright: © 2021 The Authors. Birth Defects Research published by Wiley Periodicals LLC.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: We previously explained why acardiac twinning occurs in the first trimester. We raised the question why a sudden demised monochorionic twin beyond the first trimester does not lead to acardiac twinning. We argued that exsanguinated blood from the live twin would strongly increase the demised twins' vascular resistance, preventing its perfusion and acardiac onset. However, our current hypothesis is that perfusion of the demised twin does occur but that it is insufficient for onset of acardiac twinning. Methods: We analyzed blood pressures and flows in a vascular resistance model of a monochorionic twin pregnancy where one of the fetuses demised. The resistance model consists of a demised twin with a (former) placenta, a live twin and its placenta, and arterioarterial (AA) and venovenous placental anastomoses. We assumed that only twins with a weight of at least 33% of normal survived the first trimester and that exsanguination of more than 50% of its blood volume is fatal for the live twin. Results: At 20 weeks, only AA anastomoses with radii ≲1 mm keep the exsanguinated blood volume below 50%. Then, perfusion of the deceased body with arterial blood from the live fetus is about 5–40 times smaller than when that body was alive. Beyond 20 weeks, this factor is even smaller. At 14 weeks, this factor is at most 2. Conclusion: We hypothesize that this small perfusion flow of arterial blood prevents further growth of the deceased body and hence precludes onset of acardiac twinning.
AB - Background: We previously explained why acardiac twinning occurs in the first trimester. We raised the question why a sudden demised monochorionic twin beyond the first trimester does not lead to acardiac twinning. We argued that exsanguinated blood from the live twin would strongly increase the demised twins' vascular resistance, preventing its perfusion and acardiac onset. However, our current hypothesis is that perfusion of the demised twin does occur but that it is insufficient for onset of acardiac twinning. Methods: We analyzed blood pressures and flows in a vascular resistance model of a monochorionic twin pregnancy where one of the fetuses demised. The resistance model consists of a demised twin with a (former) placenta, a live twin and its placenta, and arterioarterial (AA) and venovenous placental anastomoses. We assumed that only twins with a weight of at least 33% of normal survived the first trimester and that exsanguination of more than 50% of its blood volume is fatal for the live twin. Results: At 20 weeks, only AA anastomoses with radii ≲1 mm keep the exsanguinated blood volume below 50%. Then, perfusion of the deceased body with arterial blood from the live fetus is about 5–40 times smaller than when that body was alive. Beyond 20 weeks, this factor is even smaller. At 14 weeks, this factor is at most 2. Conclusion: We hypothesize that this small perfusion flow of arterial blood prevents further growth of the deceased body and hence precludes onset of acardiac twinning.
KW - AA and VV placental anastomoses
KW - blood perfusion
KW - deceased twin
KW - exsanguination
KW - modeling
KW - monochorionic twin pregnancy
KW - second trimester
KW - vascular resistance model
KW - venous compliance
UR - http://www.scopus.com/inward/record.url?scp=85105954046&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/bdr2.1926
DO - https://doi.org/10.1002/bdr2.1926
M3 - Article
C2 - 33999519
SN - 2472-1727
VL - 113
SP - 1103
EP - 1111
JO - Birth defects research
JF - Birth defects research
IS - 15
ER -