EP14.05: Significance of placental anastomoses and umbilical cord insertion sites in monochorionic twin pregnancy

This study aims to evaluate the impact of placental anastomoses and cord insertion site as independent risk factors for adverse fetal and neonatal outcomes. A prospective study was conducted at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome. Women with diagnosis of monochorionic pregnancy were recruited in the first trimester. After delivery, placentas were stored at 4°C and examined within 7 days. The umbilical cord of each twin was injected with dye following the method described by Lewi et al. The primary outcomes of the study were a Composite Monochorionic Pregnancy Outcome (CMPO) and a Composite Neonatal Adverse Outcome (CANO). A total of 128 patients were recruited. After confirmation of chorionicity at delivery and analysis of placental structure, only monochorionic pregnancies were considered eligible for inclusion. The analysis demonstrated the existence of a significant positive correlation between the discordance in the fetal weight of the twins and the discordance in the cord insertion sites. A positive correlation was also observed between discordance in the cord insertion sites and CMPO. No significant correlation was found between type and number of anastomoses and CMPO, and CANO. Our study reports a significant positive correlation between fetal weight discordance and discordance in the cord insertion sites. This data suggests that ultrasound evaluation of umbilical cord insertion site could be useful in predicting adverse fetal and neonatal events in monochorionic pregnancies. In this sense, we believe it is important to implement the evaluation of this ultrasound parameter to optimise risk stratification and resource allocation, thus improving the management of monochorionic twin pregnancies. Moreover, it could be very interesting to implement the evaluation of cord insertion site also in dichorionic pregnancies; in these patients a more regular ultrasound scans could alter the current management of monthly evaluations.