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| =Twin placentas= | | =Twin placentas= |
| | {{Main|Twins placentas}} |
| These are often submitted... even if they are normal. In these specimens, usually, the chorion is the key. | | These are often submitted... even if they are normal. In these specimens, usually, the chorion is the key. |
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| ==General==
| | It covers: |
| No membrane between fetuses.
| | *Monozygotic vs. dizygotic twins. |
| *Split at approx. 7th day. | | *Twin-to-twin transfusion syndrome. |
| | |
| ===Diamnionic-monochorionic (DiMo)===
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| *No interposed chorion.<ref name=Ref_H4P2_979>{{Ref H4P2|979}}</ref>
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| *Always monozygotic.
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| *Highest risk of TTTS (twin-to-twin transfusion syndrome).
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| ===Diamnionic-dichorionic (DiDi)===
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| *Most dizygotic (70%), may be monozygotic (30%).
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| *If monozygotic -- split before 3 days. | |
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| ==Twin-to-twin transfusion syndrome==
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| ===General===
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| *Abbreviated as TTTS.
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| Definition:
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| *Monozygotic twins that share a placental disc, have vessels which cross-over between the twins that lead to a blood imbalance between the two twins.
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| **Only seen in monozygotic twins.
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| **Vascular connection may be vein-to-vein, artery-to-vein, artery-to-artery (uncommon).<ref name=Ref_WMSP469>{{Ref WMSP|469}}</ref>
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| Prevalence:
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| *Seen in ~15% of monozygotic twins.<ref name=Ref_WMSP469>{{Ref WMSP|469}}</ref>
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| Clinical:
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| *Donor:
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| **Twin: hypovolemic, oliguric, oligohydramnic, +/- anemia, +/-hypoglycemia, +/- small pale organs.
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| **Placental disc: large, pale.
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| *Recipient:
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| **Twin: hypervolemia, polyuria, polyhydramnios, +/- hydrops fetalis, +/- CHF, hemolytic janundice, +/- large congested organs.
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| **Placental disc: small, firm, congested.
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| ===Gross===
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| *Large vessels that connect the two umbilical cords.
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| ===Microscopic===
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| Features:<ref name=Ref_WMSP469-70>{{Ref WMSP|469-70}}</ref>
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| *Artery-to-vein anatomosis - where artery and vein are associated with different umbilical cords.
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| *Donor twin side of placenta:
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| **Edematous villi.
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| **Increased nucleated RBCs.
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| *Recipient twin side of placenta:
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| **Congested.
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| =Diseases of the placental attachment= | | =Diseases of the placental attachment= |