PMC3445264_01
A) Transabdominal ultrasonographic image at 27 weeks of gestation showing the monochorionic-diamniotic placenta with discordant echogenicity; the hyperechogenic, thicker portion belonged to the donor twin (left), whereas the placental side of the recipient twin had a normal echotexture (right). B) Color Doppler examination showing the presence of blood flow in the depth of the placenta in the recipient (R) side. In contrast, reduced vascular Doppler signals were observed in the donor (D) side.
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F1
A. An ultrasonographic evaluation performed in our unit two days after the procedure revealed that the placental side of the donor was hyperechoic and thicker than that of the recipient's segment (Figure 1a and video clip 1). Color (Figure 1b and video clip 2) and power Doppler (video clip 3) interrogation showed reduced vascular Doppler signals within the hyperechoic portion of the placenta.
Maternal surface of the monochorionic-diamniotic placenta showing stark contrast between the donor (D) and the recipient (R) sides. The donor side is more pale and shaggy, while the recipient side is dark red, congested appearance.
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F2
Color (Figure 1b and video clip 2) and power Doppler (video clip 3) interrogation showed reduced vascular Doppler signals within the hyperechoic portion of the placenta. The placental mass of the donor was pale, while that of the recipient side had a congested appearance (Figure 2).
Histologic examination of the placenta with hematoxylin and eosin (H&E): A) The donor side shows alternating areas of edematous or fibrotic immature intermediate villi; B) The maturation pattern of chorionic villi of the recipient side is uniform and is compatible with that of a third trimester placenta.
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F3
Histologically, the placental segment of the donor showed villous dysmaturity, villous edema, intervillous hemorrhage, and features of ischemic changes such as fibrinoid degeneration of villi, villous stromal karyorrhexis, and early stromal fibrosis, while the recipient placental segment was characterized by a more uniform villous development and maturation pattern compatible with that of third trimester (Figure 3).