{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T08:46:09Z","timestamp":1751532369647,"version":"3.40.5"},"reference-count":17,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T00:00:00Z","timestamp":1621209600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We previously explained why acardiac twinning occurs in the first trimester. We raised the question why a sudden demised monochorionic twin beyond the first trimester does not lead to acardiac twinning. We argued that exsanguinated blood from the live twin would strongly increase the demised twins' vascular resistance, preventing its perfusion and acardiac onset. However, our current hypothesis is that perfusion of the demised twin <jats:italic>does<\/jats:italic> occur but that it is insufficient for onset of acardiac twinning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed blood pressures and flows in a vascular resistance model of a monochorionic twin pregnancy where one of the fetuses demised. The resistance model consists of a demised twin with a (former) placenta, a live twin and its placenta, and arterioarterial (AA) and venovenous placental anastomoses. We assumed that only twins with a weight of at least 33% of normal survived the first trimester and that exsanguination of more than 50% of its blood volume is fatal for the live twin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 20\u2009weeks, only AA anastomoses with radii \u22721\u2009mm keep the exsanguinated blood volume below 50%. Then, perfusion of the deceased body with arterial blood from the live fetus is about 5\u201340 times smaller than when that body was alive. Beyond 20\u2009weeks, this factor is even smaller. At 14\u2009weeks, this factor is at most 2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We hypothesize that this small perfusion flow of arterial blood prevents further growth of the deceased body and hence precludes onset of acardiac twinning.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1926","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T14:56:50Z","timestamp":1621263410000},"page":"1103-1111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Why does second trimester demise of a monochorionic twin not result in acardiac twinning?"],"prefix":"10.1002","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3747-6219","authenticated-orcid":false,"given":"Martin J. C.","family":"van Gemert","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering and Physics Amsterdam UMC, Location AMC  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cees W. M.","family":"van der Geld","sequence":"additional","affiliation":[{"name":"Department of Chemical Engineering and Chemistry Eindhoven University of Technology  Eindhoven The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G.","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Harbor UCLA Medical Center  Torrance California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G. J.","family":"Nikkels","sequence":"additional","affiliation":[{"name":"Department of Pathology Wilhelmina Children's Hospital, University Medical Center  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6648-8967","authenticated-orcid":false,"given":"Jeroen P. H. M.","family":"van den Wijngaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry, Hematology and Immunology Diakonessenhuis  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2011.113"},{"volume-title":"Pathology of the human placenta","year":"2006","author":"Benirschke K.","key":"e_1_2_10_3_1"},{"issue":"1","key":"e_1_2_10_4_1","first-page":"1","article-title":"Arteries of the chorion of pregnant women with arterial hypertension","volume":"3","author":"Gansburgskiy A. 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