ABSTRACT
Arteriovenous fistulas of the placenta are extremely rare in singleton pregnancies
and, to our knowledge, have not previously been reported in twin gestations. We describe
a case of an arteriovenous fistula of the placenta in a diamniotic-monochorionic twin
pregnancy complicated by twin-to-twin transfusion syndrome (TTTS). The arteriovenous
fistula was demonstrated by color-coded vascular injection studies of the placenta.
We speculate that the hemodynamic effects of the fistula may have contributed to the
refractoriness of the TTTS to serial amniodrainages and laser ablation of communicating
intertwin vessels.
KEYWORDS
Monochorionic twin - arteriovenous fistula - vascular malformation
REFERENCES
- 1
De Paepe M E, Burke S, Luks F I, Pinar H, Singer D B.
Demonstration of placental vascular anatomy in monochorionic twin gestations.
Pediatr Dev Pathol.
2002;
5
37-44
- 2
Hecher K, Diehl W, Zikulnig L, Vetter M, Hackeloer B J.
Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe
mid-trimester twin-to-twin transfusion syndrome.
Eur J Obstet Gynecol Reprod Biol.
2000;
92
135-139
- 3
Quintero R A, Morales W J, Allen M H, Bornick P W, Johnson P K, Kruger M.
Staging of twin-twin transfusion syndrome.
J Perinatol.
1999;
19
550-555
- 4
Bussey J G, Luks F, Carr S R, Plevyak M, Tracy Jr T F.
Minimal-access fetal surgery for twin-to-twin transfusion syndrome.
Surg Endosc.
2004;
18
83-86
- 5
Reiner L, Fries E.
Chorioangioma associated with arteriovenous aneurysm.
Am J Gynecol.
1965;
93
58-64
- 6
Seifer D B, Ferguson II J E, Behrens C M, Zemel S, Stevenson D K, Ross J C.
Nonimmune hydrops fetalis in association with hemangioma of the umbilical cord.
Obstet Gynecol.
1985;
66
283-286
- 7
Chiappa E, Viora E, Botta G, Abbruzzese P A, Ciriotti G, Campogrande M.
Arteriovenous fistulas of the placenta in a singleton fetus with large atrial septal
defect and anomalous connection of the umbilical veins.
Ultrasound Obstet Gynecol.
1998;
12
132-135
- 8
Berg C, Geipel A, Germer U, Gloeckner-Hofmann K, Gembruch U.
Prenatal diagnosis of umbilical cord aneurysm in a fetus with trisomy 18.
Ultrasound Obstet Gynecol.
2001;
17
79-81
Monique E De PaepeM.D.
Women and Infants' Hospital, Department of Pathology
101 Dudley Street, Providence, RI 02905
