Comparison of the ratio of placental territory discordance to birthweight discordance in placentas of monochorionic diamniotic twins

The ratio of placental territory discordance to birthweight discordance was calculated in monochorionic diamniotic twin placentas. We then determined whether the ratio: (1) correlated with the overall diameter of the placental superficial vascular anastomoses and (2) was different in normal monochorionic diamniotic twin (normal MCDA), twin-to-twin transfusion syndrome (TTTS), and selective intrauterine growth restriction (sIUGR) pregnancies. A prospective study of MCDA placentas was conducted from April 1, 2016, to April 1, 2019, including three groups, normal MCDA (N = 49), TTTS (N = 38), and sIUGR (N = 52). Placentas were studied via dye injection. In the normal MCDA, sIUGR, and TTTS groups, the ratio positively correlated with the overall diameter of the placental superficial vascular anastomoses (Spearman's = 0.295, 0.619, and 0.530; p = 0.040, <0.001, and 0.001, respectively) and gradually decreased from normal MCDA to sIUGR and to TTTS (2.88 (0.34, 64.25), 1.70 (0.27, 4.52), and 1.03 (0.12, 15.17); p < 0.001, p = 0.016/<0.001/0.005, respectively). The placental territory discordance to birthweight discordance ratio is an effective index reflecting the overall vascular anastomoses in MCDA placentas.