VELAMENTOUS CORD INSERTION IN MONOCHORIONIC TWIN GESTATION - AN ADDEDRISK FACTOR

OBJECTIVE: To study the effects of umbilical cord insertion combinatio ns on outcomes in monochorionic (MC) twin placentas. STUDY DESIGN: Six ty consecutive MC placentas were analyzed by cord insertion patterns w ith regard to growth discordance, placental parenchymal sharing, types and patterns of inter-twin vascular anastomoses, perinatal mortality and frequency of fetofetal transfusion. Corn insertions were classifie d as central/eccentric (CEN) or velamentous/marginal (VEL). RESULTS: F orty-five percent of the twins had VEL insertions. The CEN/VEL combina tion was found in 53% of pairs. The CEN/VEL group had the highest rate s of growth discordance > 20%, unequal placental parenchymal sharing, uncompensated anastomoses and perinatal demise. CONCLUSION: VEL cord i nsertion and the CEN/VEL combination are indicators of high-risk subgr oups within MC twins. VEL cord insertions can be diagnosed by ultrasou nd, identifying these high-risk groups.