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Goidescu IG, Nemeti G, Preda A, Staicu A, Goidescu CM, Surcel M, Rotar IC, Cruciat G, Muresan D. Succenturiate Placental Lobe Abruption. Int J Womens Health 2024; 16:1041-1047. [PMID: 38855357 PMCID: PMC11162245 DOI: 10.2147/ijwh.s463509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/18/2024] [Indexed: 06/11/2024] Open
Abstract
Placental development is a complex process which sets the stage for normal fetal development. Any variation/disruption occurring during the initial stages of placental formation leads to placental malfunction causing increased maternal-fetal morbidity and mortality. The succenturiate lobe is a structural variation of the placenta that usually appears as a distinct lobe from the main placental mass. Succenturiate lobe is a rare placental anomaly, with high risk of fetal distress, hemorrhage, abruptio placentae and even fetal death because the vessels of this succenturiate lobe are vulnerable to both compression and laceration. Prenatal imaging diagnosis of this pathology improves the fetal prognosis through more careful surveillance and, in case of complications such as abruptio placentae, by shortening the time-to-decision making in favor of cesarean delivery. We present the case of a 27-year-old patient, without risk factors for placental abnormalities, diagnosed antenatally with succenturiate placenta, who presented at 34 weeks of pregnancy for abruptio placentae.
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Affiliation(s)
- Iulian Gabriel Goidescu
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Georgiana Nemeti
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Andreia Preda
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Adelina Staicu
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Cerasela Mihaela Goidescu
- Department of Internal Medicine, Medical Clinic I — Internal Medicine, Cardiology and Gastroenterology, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
| | - Mihai Surcel
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Ioana Cristina Rotar
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Gheorghe Cruciat
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
| | - Daniel Muresan
- Obstetrics and Gynecology I, Mother and Child Department, University of Medicine and Pharmacy “iuliu Hatieganu”, Cluj-Napoca, 400006, Romania
- Obstetrics-Gynecology I Clinic, Emergency County Hospital, Cluj-Napoca, Romania
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Duyos I, Ordás P, Herrero B, Rodriguez R, Cabrero MJ, Fernández-Zubillaga A, Diez Sebastian JB, De La Calle M, Bartha JL, Antolín E. Single fetal demise in monochorionic twins: How to predict cerebral injury in the survivor co-twin? Acta Obstet Gynecol Scand 2023. [PMID: 37270671 PMCID: PMC10378013 DOI: 10.1111/aogs.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aims of the study were to evaluate perinatal outcome in monochorionic (MC) twins complicated with single intrauterine fetal death, spontaneously versus after fetal therapy, and to assess antenatal events that increase the risk of cerebral injury. MATERIAL AND METHODS Historical cohort study of MC pregnancies with single intrauterine fetal death diagnosed or referred to a tertiary referral hospital (2012-2020). Adverse perinatal outcome included termination of pregnancy, perinatal death, abnormal fetal or neonatal neuroimaging and abnormal neurological development. RESULTS A total of 68 MC pregnancies with single intrauterine fetal death after 14 weeks of gestation were included. Sixty-five (95.6%) occurred in complicated MC pregnancies (twin to twin transfusion syndrome: 35/68 [51.5%]; discordant malformation: 13/68 [19.1%], selective intrauterine growth restriction: 10/68 [14.7%], twin reversed arterial perfusion sequence: 5/68 [7.3%] and cord entanglement in monoamniotic twins: 2/68 [2.94%]). In 52 cases (76.5%) single intrauterine fetal demise occurred after fetal therapy and in 16 (23.5%) occurred spontaneously. Cerebral damage included 14/68 cases (20.6%): 6/68 cases (8.82%) were prenatal lesions and 8/68 cases (11.8%) were postnatal. Risk of cerebral damage tended to be higher in the spontaneous death group (6/16, 37.5%) compared to the therapy-group (8/52, 15.38%) (p = 0.07). The risk increased with gestational age at intrauterine death (OR 1.21, 95% CI: 1.04-1.41, p = 0.014) and was higher in those surviving co-twins who developed anemia (OR 9.27, 95% CI: 1.50-57.12, p = 0.016). Pregnancies complicated with selective intrauterine growth restriction tended to be at higher risk for neurological damage (OR 2.85, 95% CI: 0.68-11.85, p = 0.15). Preterm birth rate (<37 weeks of pregnancy) was 61.7% (37/60). Seven of eight postnatal cerebral lesions (87.5%) were related to extreme prematurity. Overall perinatal survival rate was 88.3% (57/68) and 7% (4/57) of children had an abnormal neurological outcome. CONCLUSIONS Risk of cerebral damage in single intrauterine fetal death is especially high when it occurs spontaneously. Gestational age at single intrauterine fetal death, selective intrauterine growth restriction and anemia of the surviving co-twin are the main predictors for prenatal lesions and might be useful in parent counseling. Abnormal postnatal neurological outcome is closely related to extreme prematurity.
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Affiliation(s)
- Inmaculada Duyos
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Polán Ordás
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Beatriz Herrero
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Roberto Rodriguez
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Miguel Jesús Cabrero
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | | | | | - María De La Calle
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolín
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
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Prayer D, Malinger G, De Catte L, De Keersmaecker B, Gonçalves LF, Kasprian G, Laifer-Narin S, Lee W, Millischer AE, Platt L, Prayer F, Pugash D, Salomon LJ, Sanz Cortes M, Stuhr F, Timor-Tritsch IE, Tutschek B, Twickler D, Raine-Fenning N. ISUOG Practice Guidelines (updated): performance of fetal magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:278-287. [PMID: 36722431 PMCID: PMC10107509 DOI: 10.1002/uog.26129] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 05/03/2023]
Affiliation(s)
- D Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - G Malinger
- Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L De Catte
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - B De Keersmaecker
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L F Gonçalves
- Fetal Imaging, William Beaumont Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - S Laifer-Narin
- Division of Ultrasound and Fetal MRI, Columbia University Medical Center - New York Presbyterian Hospital, New York, NY, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - A-E Millischer
- Radiodiagnostics Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - L Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - F Prayer
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - D Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, Canada
| | - L J Salomon
- Department of Obstetrics, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Paris, France
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - F Stuhr
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, NYU Grossmann School of Medicine, New York, NY, USA
| | - B Tutschek
- Department of Obstetrics & Gynecology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Prenatal Zurich, Zürich, Switzerland
| | - D Twickler
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N Raine-Fenning
- Department of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK; Nurture Fertility, The Fertility Partnership, Nottingham, UK
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