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Difference between revisions of "Twin placentas"
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→Twin-to-twin transfusion syndrome
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*Split at approximately 7th day. | *Split at approximately 7th day. | ||
*Always monozygotic twins. | *Always monozygotic twins. | ||
*Very rare. | |||
*High rate of complications - cords get into knots. | |||
===Gross=== | ===Gross=== | ||
*No membrane between the fetuses - apparently clinically. | *No membrane between the fetuses - apparently clinically. | ||
*Umbilical cord attachments usually very close to one another.<ref name=Ref_Placenta133>{{Ref Placenta|133}}</ref> | |||
==Diamniotic-monochorionic gestation== | ==Diamniotic-monochorionic gestation== | ||
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===General=== | ===General=== | ||
*The dogma is that the twins are always monozygotic. | *The dogma is that the twins are always monozygotic. | ||
**There is a case report of an exception.<ref>PMID | **There is a case report of an exception.<ref name=pmid12853583>{{Cite journal | last1 = Redline | first1 = RW. | title = Nonidentical twins with a single placenta--disproving dogma in perinatal pathology. | journal = N Engl J Med | volume = 349 | issue = 2 | pages = 111-4 | month = Jul | year = 2003 | doi = 10.1056/NEJMp030097 | PMID = 12853583 }}</ref> | ||
*Highest risk of TTTS ([[twin-to-twin transfusion syndrome]]). | *Highest risk of TTTS ([[twin-to-twin transfusion syndrome]]). | ||
===Gross=== | ===Gross=== | ||
Features - T-zone membrane is:<ref name=Ref_Placenta128>{{Ref Placenta|128}}</ref> | |||
*Thin. | |||
*Translucent. | |||
*No blood vessel remnants. | |||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref | Features:<ref>URL: [http://library.med.utah.edu/WebPath/PLACHTML/PLAC006.html http://library.med.utah.edu/WebPath/PLACHTML/PLAC006.html]. Accessed on: 30 October 2013.</ref> | ||
* | *No chorion in the T-zone - '''key feature'''. | ||
====Images==== | ====Images==== | ||
<gallery> | |||
Image:Monochorionic Diamniotic Twins, Intervening Membrane.jpg | Di-Mo placenta. (WC/euthman) | |||
</gallery> | |||
*[http://www.pathologypics.com/PictView.aspx?ID=1304 Diamniotic-monochorionic gestation (pathologypics.com)]. | *[http://www.pathologypics.com/PictView.aspx?ID=1304 Diamniotic-monochorionic gestation (pathologypics.com)]. | ||
*[http://library.med.utah.edu/WebPath/PLACHTML/PLAC006.html Di-Mo placenta (utah.edu)]. | *[http://library.med.utah.edu/WebPath/PLACHTML/PLAC006.html Di-Mo placenta (utah.edu)]. | ||
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===Gross=== | ===Gross=== | ||
*Thick | Features - T-zone:<ref name=Ref_Placenta129>{{Ref Placenta|129}}</ref> | ||
*Thick. | |||
*Less translucent. | |||
*Blood vessels - fine branching. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *Chorion present in the T-zone. | ||
====Images==== | ====Images==== | ||
*[http://library.med.utah.edu/WebPath/PLACHTML/PLAC005.html | <gallery> | ||
Image:Diamniotic-dichorionic_twin_placenta_-_low_mag.jpg | DiDi placenta. (WC) | |||
Image:Diamniotic dichorionic placenta, HE 1.jpg | DiDi placenta. (WC/euthman) | |||
Image:Diamniotic dichorionic placenta, HE 2.jpg | DiDi placenta. (WC/euthman) | |||
</gallery> | |||
*[http://library.med.utah.edu/WebPath/PLACHTML/PLAC005.html DiDi placenta (utah.edu)]. | |||
===Sign out=== | ===Sign out=== | ||
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**Placental disc: large, pale. | **Placental disc: large, pale. | ||
*Recipient: | *Recipient: | ||
**Twin: hypervolemia, polyuria, polyhydramnios, +/- [[hydrops fetalis]], +/- CHF, hemolytic janundice, +/- large congested organs. | **Twin: hypervolemia, polyuria, [[polyhydramnios]], +/- [[hydrops fetalis]], +/- CHF, hemolytic janundice, +/- large congested organs. | ||
**Placental disc: small, firm, congested. | **Placental disc: small, firm, congested. | ||