{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:00:13Z","timestamp":1792522813310,"version":"4.5.0"},"reference-count":17,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:00:00Z","timestamp":1639008000000},"content-version":"unspecified","delay-in-days":69,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Twin Res Hum Genet"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We report a case of a monochorionic diamniotic twin with an uncomplicated pregnancy, but with an unexpected large intertwin hemoglobin (Hb) difference at birth. Twin 1 was delivered vaginally and had an uneventful neonatal course. The umbilical cord of Twin 1 was clamped approximately 5 min after birth. After the birth of Twin 1, Twin 2 developed severe bradycardia and showed limited cardiac output on ultrasound, for which an emergency cesarean section was performed. A full blood count revealed an Hb of 20.1 g\/dL for Twin 1 and 10.2 g\/dL for Twin 2 (intertwin difference 9.9 g\/dL). Reticulocyte counts were similar, 40\u2030 and 38\u2030, respectively. Placental examination revealed 10 vascular anastomoses, including one arterio-arterial anastomosis with a diameter of 1.4 mm. Additionally, a large chorangioma was present on the placental surface of Twin 2. There was no color difference on the maternal side of the placenta. Based on the reticulocyte count ratio and the placental characteristics, twin anemia polycythemia sequence was ruled out as the cause of the large intertwin Hb difference. In this report, we discuss the various potential causes that could explain the large intertwin Hb difference including the role of delayed cord clamping in Twin 1, and the role of a large chorangioma, which may have attracted blood from the fetal circulation of Twin 2.<\/jats:p>","DOI":"10.1017\/thg.2021.46","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T09:11:26Z","timestamp":1639041086000},"page":"281-284","source":"Crossref","is-referenced-by-count":4,"title":["Large Hemoglobin Differences at Birth in Monochorionic Twins with a Placental Chorangioma and Delayed Cord Clamping"],"prefix":"10.1017","volume":"24","author":[{"given":"Sophie G.","family":"Groene","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisanne S.A.","family":"Tollenaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotte E.","family":"van der Meeren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke","family":"Slaghekke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Joanne","family":"Verweij","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart B.","family":"Hooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjan B.","family":"te Pas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Lopriore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,12,9]]},"reference":[{"key":"S1832427421000463_ref2","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1055\/s-0034-1372428","article-title":"Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment","volume":"31","author":"Benoit","year":"2014","journal-title":"American Journal of Perinatology"},{"key":"S1832427421000463_ref17","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.23"},{"key":"S1832427421000463_ref12","doi-asserted-by":"publisher","DOI":"10.1080\/15513819609168713"},{"key":"S1832427421000463_ref4","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2013-0170"},{"key":"S1832427421000463_ref5","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2018.00372"},{"key":"S1832427421000463_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/S1526-9523(01)00196-9"},{"key":"S1832427421000463_ref6","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19013"},{"key":"S1832427421000463_ref14","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20096"},{"key":"S1832427421000463_ref9","first-page":"e3208","article-title":"Accurate and simple evaluation of vascular anastomoses in monochorionic placenta using colored dye","author":"Lopriore","year":"2011","journal-title":"Journal of Visualized Experiments"},{"key":"S1832427421000463_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2017.07.008"},{"key":"S1832427421000463_ref16","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2016-311822"},{"key":"S1832427421000463_ref1","doi-asserted-by":"publisher","DOI":"10.3109\/15513815.2010.487009"},{"key":"S1832427421000463_ref3","volume-title":"Pathology of the human placenta","author":"Bernischke","year":"2012"},{"key":"S1832427421000463_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12114"},{"key":"S1832427421000463_ref10","doi-asserted-by":"publisher","DOI":"10.1002\/ebch.1971"},{"key":"S1832427421000463_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2006.01.010"},{"key":"S1832427421000463_ref13","first-page":"CD003248","article-title":"Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes","volume":"9","author":"Rabe","year":"2019","journal-title":"Cochrane Database of System Reviews"}],"container-title":["Twin Research and Human Genetics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1832427421000463","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T09:58:09Z","timestamp":1642759089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1832427421000463\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["S1832427421000463"],"URL":"https:\/\/doi.org\/10.1017\/thg.2021.46","relation":{},"ISSN":["1832-4274","1839-2628"],"issn-type":[{"value":"1832-4274","type":"print"},{"value":"1839-2628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}