Document Detail


Placental findings after laser ablation of communicating vessels in twin-to-twin transfusion syndrome.
MedLine Citation:
PMID:  15022066     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
As laser ablation of placental vascular communications gains acceptance as treatment option for severe twin-to-twin transfusion syndrome (TTTS), pathologists are increasingly confronted with the interpretation of laser-treated placentas. We present our preliminary institutional experience with the gross and microscopic analysis of these specimens. Patients underwent selective ablation for severe TTTS (Quintero stages II to V) between 16 and 25 wk gestation and the placentas were examined between < 24 h and 19 wk postoperatively. The placental vasculature was injected with gelatin-dye mixtures. The type and number of vascular anastomoses were recorded, followed by routine histopathological analysis of the placenta. Foci of laser impact were identified in all placentas examined within 1 month after laser coagulation. Located along the recipient side of the dividing membrane, the laser-treated vessels appeared hemorrhagic and showed a characteristic abrupt interruption of dye filling after vascular injection. In placentas examined more than 1 month after intervention, the most frequent gross finding was the absence or relative paucity of intertwin anastomoses, associated with subchorionic fibrin deposition. Microscopically, laser-treated vessels showed varying degrees of necrosis, associated with focal hemorrhage, avascular villi, and fibrin deposition in the underlying parenchyma. In some cases of intrauterine fetal demise or placental disruption, no definite laser scars were identified. As expected, the number of residual anastomoses (all types) was significantly smaller in laser-treated placentas than in control monochorionic placentas (2.4 +/- 2.2 [ n = 10] vs. 6.2 +/- 3.2 [ n = 70], P < 0.01). Velamentous cord insertion was noted in 50% of cases; markedly uneven placental sharing in 60%. Detailed analysis of laser-treated placentas and clinicopathological correlation may lead to a better understanding of the pathophysiology of TTTS and continued refinement of therapeutic approaches for this often lethal condition.
Authors:
Monique E De Paepe; Rebecca M Friedman; Michael Poch; Katrine Hansen; Stephen R Carr; Francois I Luks
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Publication Detail:
Type:  Journal Article     Date:  2004-03-17
Journal Detail:
Title:  Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society     Volume:  7     ISSN:  1093-5266     ISO Abbreviation:  Pediatr. Dev. Pathol.     Publication Date:    2004 Mar-Apr
Date Detail:
Created Date:  2004-05-31     Completed Date:  2004-12-15     Revised Date:  2006-05-08    
Medline Journal Info:
Nlm Unique ID:  9809673     Medline TA:  Pediatr Dev Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  159-65     Citation Subset:  IM    
Affiliation:
Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA. mdepaepe@wihri.org
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MeSH Terms
Descriptor/Qualifier:
Female
Fetofetal Transfusion / surgery*
Humans
Laser Coagulation / adverse effects*
Placenta / blood supply,  pathology*,  surgery
Placental Circulation
Pregnancy
Time Factors
Comments/Corrections
Comment In:
Pediatr Dev Pathol. 2004 Mar-Apr;7(2):105   [PMID:  15170268 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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