Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome
Abstract Introduction Our objective was to investigate the association between the presence of placental anastomoses and intertwin differences in renin‐angiotensin‐aldosterone activation in monochorionic twins using amniotic fluid aldosterone (AF‐ALD) levels. In addition, this study also examined th...
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Wiley
2024-08-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14859 |
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| author | Mayumi Takano Mayu Tachihara Mio Kamiya Hikari Kotaki Makiko Shimabukuro Sumito Nagasaki Masahiko Nakata |
| author_facet | Mayumi Takano Mayu Tachihara Mio Kamiya Hikari Kotaki Makiko Shimabukuro Sumito Nagasaki Masahiko Nakata |
| author_sort | Mayumi Takano |
| collection | DOAJ |
| description | Abstract Introduction Our objective was to investigate the association between the presence of placental anastomoses and intertwin differences in renin‐angiotensin‐aldosterone activation in monochorionic twins using amniotic fluid aldosterone (AF‐ALD) levels. In addition, this study also examined the association between AF‐ALD and the ALD levels in the umbilical cord blood (UCB‐ALD) in monochorionic twins. Material and Methods This prospective study included monochorionic diamniotic (MD) twin pregnancies that were not complicated by twin‐to‐twin transfusion syndrome (TTTS) at delivery. Amniotic fluid and umbilical cord vein blood samples were collected from each twin at delivery, and the ALD levels were measured subsequently. The MD twins were divided into two groups: those with placental anastomoses and those without anastomoses owing to fetoscopic laser surgery. The differences in the AF‐ALD levels between the larger and smaller twins were analyzed. Results The AF‐ALD levels showed a strong and significant positive correlation with UCB‐ALD levels in 131 MD twins (r = 0.804, p < 0.001). Intertwin differences were examined in 41 and 28 pairs of MD twins with and without placental anastomoses, respectively. The AF‐ALD levels in the smaller twins were significantly higher than those in the larger twins among the pairs of MD twins with placental anastomoses (p = 0.003); however, no statistically significant intertwin differences were observed among the twins without placental anastomoses (p > 0.05). Conclusions The AF‐ALD levels reflect the UCB‐ALD levels in MD twins. The presence of placental anastomoses led to intertwin discordance in the ALD levels in MD twins even uncomplicated with TTTS. It was considered that monochorionic twins have this clinical background, and it leads to the development of TTTS. |
| format | Article |
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| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-3afd8b935ef84525ae812b0bce822fae2025-08-20T03:22:18ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-08-0110381558156310.1111/aogs.14859Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndromeMayumi Takano0Mayu Tachihara1Mio Kamiya2Hikari Kotaki3Makiko Shimabukuro4Sumito Nagasaki5Masahiko Nakata6Department of Obstetrics and Gynecology Toho University Omori Medical Center Tokyo JapanDepartment of Obstetrics and Gynecology Toho University Omori Medical Center Tokyo JapanDepartment of Obstetrics and Gynecology Toho University Omori Medical Center Tokyo JapanDepartment of Obstetrics and Gynecology Toho University Omori Medical Center Tokyo JapanDepartment of Obstetrics and Gynecology Toho University Omori Medical Center Tokyo JapanDepartment of Obstetrics and Gynecology Toho University Omori Medical Center Tokyo JapanDepartment of Obstetrics and Gynecology Toho University Omori Medical Center Tokyo JapanAbstract Introduction Our objective was to investigate the association between the presence of placental anastomoses and intertwin differences in renin‐angiotensin‐aldosterone activation in monochorionic twins using amniotic fluid aldosterone (AF‐ALD) levels. In addition, this study also examined the association between AF‐ALD and the ALD levels in the umbilical cord blood (UCB‐ALD) in monochorionic twins. Material and Methods This prospective study included monochorionic diamniotic (MD) twin pregnancies that were not complicated by twin‐to‐twin transfusion syndrome (TTTS) at delivery. Amniotic fluid and umbilical cord vein blood samples were collected from each twin at delivery, and the ALD levels were measured subsequently. The MD twins were divided into two groups: those with placental anastomoses and those without anastomoses owing to fetoscopic laser surgery. The differences in the AF‐ALD levels between the larger and smaller twins were analyzed. Results The AF‐ALD levels showed a strong and significant positive correlation with UCB‐ALD levels in 131 MD twins (r = 0.804, p < 0.001). Intertwin differences were examined in 41 and 28 pairs of MD twins with and without placental anastomoses, respectively. The AF‐ALD levels in the smaller twins were significantly higher than those in the larger twins among the pairs of MD twins with placental anastomoses (p = 0.003); however, no statistically significant intertwin differences were observed among the twins without placental anastomoses (p > 0.05). Conclusions The AF‐ALD levels reflect the UCB‐ALD levels in MD twins. The presence of placental anastomoses led to intertwin discordance in the ALD levels in MD twins even uncomplicated with TTTS. It was considered that monochorionic twins have this clinical background, and it leads to the development of TTTS.https://doi.org/10.1111/aogs.14859aldosteroneamniotic fluidmonochorionic twinstwin‐to‐twin transfusion syndrome |
| spellingShingle | Mayumi Takano Mayu Tachihara Mio Kamiya Hikari Kotaki Makiko Shimabukuro Sumito Nagasaki Masahiko Nakata Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome Acta Obstetricia et Gynecologica Scandinavica aldosterone amniotic fluid monochorionic twins twin‐to‐twin transfusion syndrome |
| title | Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome |
| title_full | Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome |
| title_fullStr | Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome |
| title_full_unstemmed | Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome |
| title_short | Intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins: Insight into the pathophysiology of twin‐to‐twin transfusion syndrome |
| title_sort | intertwin discordance of aldosterone levels in amniotic fluid with placental anastomoses in monochorionic twins insight into the pathophysiology of twin to twin transfusion syndrome |
| topic | aldosterone amniotic fluid monochorionic twins twin‐to‐twin transfusion syndrome |
| url | https://doi.org/10.1111/aogs.14859 |
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