{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:15:35Z","timestamp":1787498135583,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,12,21]],"date-time":"2015-12-21T00:00:00Z","timestamp":1450656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>A total of 75% of monozygotic twins share 1 monochorionic placenta where placental anastomoses cause several serious complications, for example, acardiac twinning. Acardiac twins lack cardiac function but grow by perfusion of arterial blood from the pump twin. This rare pregnancy has 50% natural pump twin mortality but accurate risk prediction is currently impossible. Recent guidelines suggest prophylactic surgery before 18 weeks, suggesting 50% unnecessary interventions. We hypothesize that (1) adverse pump twin outcome relates to easy\u2010to\u2010measure pump\/acardiac umbilical venous diameter (UVD) ratios, representing acardiac perfusion by the pump's excess cardiac output. This hypothesis suggests that (2) UVD\u2010ratios are large, mildly varying in cases without complications but small and decreasing when complications develop, thus predicting that (3) UVD\u2010ratios may allow risk prediction of pump twins. In this exploratory clinical pilot, we tested whether UVD\u2010ratio measurements support these predictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We included 7 uncomplicated (expectant management), 3 elective surgical, and 17 complicated cases (pump decompensation, emergency intervention\/delivery or demise). Nine UVD\u2010ratios were measured sonographycally and 18 by pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Uncomplicated cases have larger, two serial measurements showing mildly varying UVD\u2010ratios; elective surgical cases show larger UVD\u2010ratios; complicated cases have smaller, two serial measurements showing decreasing UVD\u2010ratios. There were no false\u2010positives, no false\u2010negatives and noncrossing linear trendlines of uncomplicated and complicated cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Our data provide first evidence that UVD\u2010ratios allow risk prediction of pump twins. More early uncomplicated and late complicated cases are needed, for example, in a prospective trial, before the separation between uncomplicated and complicated cohorts is accurate enough to support a well\u2010founded decision on (early) intervention. Birth Defects Research (Part A) 106:114\u2013121, 2016. \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bdra.23467","type":"journal-article","created":{"date-parts":[[2015,12,21]],"date-time":"2015-12-21T09:12:48Z","timestamp":1450689168000},"page":"114-121","source":"Crossref","is-referenced-by-count":17,"title":["Hypothesis acardiac twin pregnancies: Pathophysiology\u2010based hypotheses suggest risk prediction by pump\/acardiac umbilical venous diameter ratios"],"prefix":"10.1002","volume":"106","author":[{"given":"Martin J.C.","family":"van Gemert","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering &amp; Physics Academic Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lourens R.","family":"Pistorius","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Medical Center Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Benirschke","sequence":"additional","affiliation":[{"name":"Department of Pathology University of California at San Diego San Diego California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gouke J.","family":"Bonsel","sequence":"additional","affiliation":[{"name":"Department of Public Health and Obstetrics and Gynecology Erasmus Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank P.H.A.","family":"Vandenbussche","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Marieke","family":"Paarlberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Gelre Teaching Hospitals Apeldoorn The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen P.H.M.","family":"van den Wijngaard","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering &amp; Physics Academic Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.J.","family":"Nikkels","sequence":"additional","affiliation":[{"name":"Department of Pathology, Wilhelmina Children's Hospital University Medical Center Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,12,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70456-4"},{"key":"e_1_2_6_3_1","first-page":"180","volume-title":"An introduction to fluid dynamics","author":"Batchelor GK","year":"1967"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2009.08.009"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2008.27.7.1105"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(99)00404-4"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2010.09.003"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1902.tb15905.x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.113906"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1389.023"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.2350\/14-02-1437-OA.1"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2009.02.005"},{"key":"e_1_2_6_13_1","first-page":"647","article-title":"Holoacardius: review of the literature and case report","volume":"2","author":"Gillim DL","year":"1953","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/tera.1420500306"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20473"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(15)30757-2"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.04.018"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0026-2862(74)90038-7"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2006.01.010"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(90)91094-S"},{"key":"e_1_2_6_21_1","volume-title":"Normal values in pregnancy","author":"Ramsay MM","year":"2000"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/15513810801893389"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1944"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0143-4004(98)90009-1"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001703-200104000-00015"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/50\/3\/N03"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23405"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1269"}],"container-title":["Birth Defects Research Part A: Clinical and Molecular Teratology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbdra.23467","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdra.23467","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T06:47:33Z","timestamp":1696574853000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/bdra.23467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12,21]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,2]]}},"alternative-id":["10.1002\/bdra.23467"],"URL":"https:\/\/doi.org\/10.1002\/bdra.23467","archive":["Portico"],"relation":{},"ISSN":["1542-0752","1542-0760"],"issn-type":[{"value":"1542-0752","type":"print"},{"value":"1542-0760","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12,21]]}}}