Reference center for rare placental pathologies in monochorionic pregnancies (PaRaDiGM)
The area of expertise of the reference center for rare placental pathologies in monochorionic pregnancies (PaRaDiGM) includes rare complications related to the specific vascularization of the placentas of monochorionic multiple pregnancies and their consequences on the children resulting from these pregnancies.
Multiple pregnancies from monochorionic placentation represent 0.4% of pregnancies, i.e. around 2800 pregnancies / year in France.
There are four rare and specific complications, occurring in 15% of these monochorionic pregnancies:
- Twin to twin transfusion syndrome (TTTS)
- Twin anemia-polycythemia sequence(TAPS)
- Twin Reversed Arterial Perfusion (TRAP) sequence
- Selective intrauterine growth restriction (sIUGR) with severe hemodynamic disorders
When these complications occur, the treatment consists of performing in utero fetoscopic surgery performed by a fetal medicine center of expertise.
Children resulting from these complicated pregnancies are at risk of specific hemodynamic and metabolic disorders, which require special paediatric care.
This reference center is affiliated with the AnDDI-Rares rare diseases healthcare network.
Keywords: Twin pregnancy, monochorionic pregnancy, twin to twin transfusion syndrome, selective intrauterine growth restriction, TAPS (twin anemia polycythemia sequence), TRAP (twin reversed arterial perfusion sequence)
Medical
team
Pr Yves Ville
MD, PhD
Dr Claire Colmant
MD, PhD
In case of emergency
There are four rare and specific complications, occurring in 15% of these monochorionic pregnancies:
- Twin to twin transfusion syndrome (TTTS)
- Twin anemia-polycythemia sequence(TAPS)
- Twin reversed arterial perfusion (TRAP) sequence
- Selective intrauterine growth restriction (sIUGR) with severe hemodynamic disorders
- Pr Yves Ville, surgeon in obstetrics and gynecology
- Dr Claire Colmant, surgeon in obstetrics and gynecology
- Pr Laurent Salomon, surgeon in obstetrics and gynecology
- Dr Julien Stirnemann, surgeon in obstetrics and gynecology
- Dr Laurence Bussières, clinical research unit biologist
- Contribution of magnetic resonance imaging (MRI) : Thanks to the creation of the clinical research platform in foetal imaging “LUMIERE”, located at the Necker-Enfants malades hospital, our team was able to acquire a 1.5-tesla MRI machine dedicated to the foetus exploration during pregnancy. The aims are :
- The identification of placental functional variations using functional MRI sequences (T2*, BOLD, etc.)
- To improve preoperative placental mapping to optimize surgical care
- The early assessment of impact on foetal and neonatal brain development
- Functional genomics : Thanks to collaborations with teams from the Imagine Institute and the CNRS, whose expertise is renowned for high throughput sequencing, our team will submit a generic call for projects to the ANR in order to identify the transcriptional and epigenetic variations linked to placental pathologies of monochorionic pregnancies. The ultimate objective would be to identify early markers of complications during monochorionic pregnancy.
Furthermore, the national project, “Pediatric follow-up of twins with twin-twin transfusion syndrome at 4 and 6 years of age”, of which our coordinating centre is the principal investigator, lunched in 2004, is still ongoing in order to follow the future of these children in adolescence until the age of 20. This cohort will therefore be one of the only ones whose patient active file is followed, up to adulthood.
Inter-university diploma in gynecological and obstetrical ultrasound
Paris Cité, Paris-Est Créteil, Strasbourg, Brest, Bordeaux, Clermont-Ferrand, Lille, Lyon, Marseille, Nantes, Toulouse and Tours universities.
Inter-university diploma in fetal medicine
Paris Cité, Paris Saclay, Bordeaux, Lille, Montpellier, Rennes and Tours universities.
BCPP master option « prenatal screening » or « fetal medicine diagnosis ».
Paris Cité university
2022
- Selective vs complete fetoscopic coagulation of vascular equator: a matched comparative study.
Bartin R, Colmant C, Bourgon N, Carrier A, Ville Y, Stirnemann J.
Am J Obstet Gynecol. 2022 Sep, PMID: 35500610 DOI: 10.1016/j.ajog.2022.04.047 - Effect of gestational age at laser therapy on perinatal outcome in monochorionic diamniotic pregnancies affected by twin-to-twin transfusion syndrome.
Bartin R, Colmant C, Bourgon N, Ville Y, Stirnemann J
BJOG. 2022 Nov, PMID: 35596696 DOI: 10.1111/1471-0528.17228
2021
- Intrauterine fetoscopic laser surgery versus expectant management in stage 1 twin-to-twin transfusion syndrome: an international randomized trial.
Stirnemann J, Slaghekke F, Khalek N, Winer N, Johnson A, Lewi L, Massoud M, Bussieres L, Aegerter P, Hecher K, Senat MV, Ville Y.
Am J Obstet Gynecol. 2021 May, PMID: 33248135 DOI: 10.1016/j.ajog.2020.11.031 - Impact of different prenatal management strategies in short- and long-term outcomes in monochorionic twin pregnancies with selective intrauterine growth restriction and abnormal flow velocity waveforms in the umbilical artery Doppler: a retrospective observational study of 108 cases.
Colmant C, Lapillonne A, Stirnemann J, Belaroussi I, Leroy-Terquem E, Kermovant-Duchemin E, Bussieres L, Ville Y.
BJOG. 2021 Jan, PMID: 32416618 DOI: 10.1111/1471-0528.16318
2020
- Management of monochorionic twins discordant for structural fetal anomalies.
Corroenne R, Al Ibrahim A, Stirnemann J, Zayed LH, Essaoui M, Russell NE, Chalouhi GE, Salomon LJ, Ville Y.
Prenat Diagn. 2020 Oct, PMID: 32394424 DOI: 10.1002/pd.5734 - Magnetic resonance imaging-based three-dimensional modeling of pregnant pelvis for fetoscopic surgical planning.
Badaoui S, Grevent D, Salomon LJ, Ville Y, Stirnemann J.
Ultrasound Obstet Gynecol. 2020 Nov, PMID: 32365244 DOI: 10.1002/uog.22067
2019
- Good clinical practice advice: Management of twin pregnancy.
FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine.
Int J Gynaecol Obstet. 2019 Mar, PMID: 30710359 DOI: 10.1002/ijgo.12742
2018
- Impact of laser therapy for twin-to-twin transfusion syndrome on subsequent pregnancy.
Le Lous M, Mediouni I, Chalouhi G, Salomon LJ, Bussières L, Carrier A, Bernard JP, Ville Y.
Prenat Diagn. 2018 Mar, PMID: 29417606 DOI: 10.1002/pd.5227 - Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases.
Stirnemann J, Djaafri F, Kim A, Mediouni I, Bussieres L, Spaggiari E, Veluppillai C, Lapillonne A, Kermorvant E, Magny JF, Colmant C, Ville Y.
BJOG. 2018 Aug, PMID: 29380497 DOI: 10.1111/1471-0528.15147 - Fetal brain imaging following laser surgery in twin-to-twin surgery.
Stirnemann J, Chalouhi G, Essaoui M, Bahi-Buisson N, Sonigo P, Millischer AE, Lapillonne A, Guigue V, Salomon LJ, Ville Y.
BJOG. 2018 Aug, PMID: 27348600 DOI: 10.1111/1471-0528.14162
2017
- Twin-twin transfusion syndrome – What we have learned from clinical trials.
Djaafri F, Stirnemann J, Mediouni I, Colmant C, Ville Y.
Semin Fetal Neonatal Med. 2017 Dec, PMID: 29122542 DOI: 10.1016/j.siny.2017.08.005
2016
- Outcome of triplet pregnancies managed for twin-to-twin transfusion syndrome: A single center experience].
Chalouhi GE, Quibel T, Benzina N, Bernard JP, Essaoui M, Ville Y.
J Gynecol Obstet Biol Reprod (Paris). 2016 Oct, PMID: 26995685 DOI: 10.1016/j.jgyn.2015.08.006 - Twin-to-Twin Transfusion Syndrome: From Observational Evidence to Randomized Controlled Trials.
Stirnemann J, Chalouhi G, Ville Y.
Twin Res Hum Genet. 2016 Jun, PMID: 27075108 DOI: 10.1017/thg.2016.22 - Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms.
Beauquier-Maccotta B, Chalouhi GE, Picquet AL, Carrier A, Bussières L, Golse B, Ville Y.
PLoS One. 2016 Jan 11, PMID: 26751570 PMCID: PMC4709103 DOI: 10.1371/journal.pone.0145649 - The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin–Twin Transfusion Syndrome.
Petersen SG, Gibbons KS, Luks FI, Lewi L, Diemert A, Hecher K, Dickinson JE, Stirnemann JJ, Ville Y, Devlieger R, Gardener G, Deprest JA.
Fetal Diagn Ther. 2016, PMID: 27073886 DOI: 10.1159/000441915 - ISUOG Practice Guidelines: role of ultrasound in twin pregnancy.
Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, Kilby MD, Lewi L, Nicolaides KH, Oepkes D, Raine-Fenning N, Reed K, Salomon LJ, Sotiriadis A, Thilaganathan B, Ville Y.
Ultrasound Obstet Gynecol. 2016 Feb, PMID: 26577371 DOI: 10.1002/uog.15821
2015
- Pulmonary stenosis in complicated monochorionic twin pregnancies: prevalence, management and outcome.
Stagnati V, Chalouhi GE, Essaoui M, Giuseppi A, Stirnemann JJ, Le Bidois J, Ville Y.
Prenat Diagn. 2015 Nov, PMID: 26179089 DOI: 10.1002/pd.4650
2013
- Active management of selective intrauterine growth restriction with abnormal Doppler in monochorionic diamniotic twin pregnancies diagnosed in the second trimester of pregnancy.
Chalouhi GE, Marangoni MA, Quibel T, Deloison B, Benzina N, Essaoui M, Al Ibrahim A, Stirnemann JJ, Salomon LJ, Ville Y.
Prenat Diagn. 2013 Feb, PMID: 23280487 DOI: 10.1002/pd.4031 - A nomogram for perioperative prognostic risk-assessment in twin-twin transfusion syndrome.
Stirnemann JJ, Nasr B, Essaoui M, Bussieres L, Ville Y.
Prenat Diagn. 2013 Feb, PMID: 23172548 DOI: 10.1002/pd.4015
2012
- Timing of delivery following selective laser photocoagulation for twin-to-twin transfusion syndrome.
Stirnemann JJ, Quibel T, Essaoui M, Salomon LJ, Bussieres L, Ville Y.
Am J Obstet Gynecol. 2012 Aug, PMID: 22840722 DOI: 10.1016/j.ajog.2012.06.042 - [Management of twin-to-twin transfusion syndrome].
Chalouhi GE, Deloison B, Ville Y.
Gynecol Obstet Fertil. 2012 Mar, PMID: 22387235 DOI: 10.1016/j.gyobfe.2012.01.009
2011
- Laser therapy for twin-to-twin transfusion syndrome (TTTS).
Chalouhi GE, Essaoui M, Stirnemann J, Quibel T, Deloison B, Salomon L, Ville Y.
Prenat Diagn. 2011 Jul, PMID: 21660997 DOI: 10.1002/pd.2803 - Twin pregnancies: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF).
Vayssière C, Benoist G, Blondel B, Deruelle P, Favre R, Gallot D, Jabert P, Lemery D, Picone O, Pons JC, Puech F, Quarello E, Salomon L, Schmitz T, Senat MV, Sentilhes L, Simon A, Stirneman J, Vendittelli F, Winer N, Ville Y; French College of Gynaecologists and Obstetricians.
Eur J Obstet Gynecol Reprod Biol. 2011 May, PMID: 21277672 DOI: 10.1016/j.ejogrb.2010.12.045
2010
- Specific complications of monochorionic twin pregnancies: twin-twin transfusion syndrome and twin reversed arterial perfusion sequence.
Chalouhi GE, Stirnemann JJ, Salomon LJ, Essaoui M, Quibel T, Ville Y.
Semin Fetal Neonatal Med. 2010 Dec, PMID: 20855238 DOI: 10.1016/j.siny.2010.09.003 - Evaluation of the CHOP cardiovascular score as a prognostic predictor of outcome in twin-twin transfusion syndrome after laser coagulation of placental vessels in a prospective cohort.
Stirnemann JJ, Nasr B, Proulx F, Essaoui M, Ville Y.
Ultrasound Obstet Gynecol. 2010 Jul, PMID: 20582931 DOI: 10.1002/uog.7713 - Long-term developmental follow-up of infants who participated in a randomized clinical trial of amniocentesis vs laser photocoagulation for the treatment of twin-to-twin transfusion syndrome.
Salomon LJ, Ortqvist L, Aegerter P, Bussieres L, Staracci S, Stirnemann JJ, Essaoui M, Bernard JP, Ville Y.
Am J Obstet Gynecol. 2010 Nov, PMID: 21055511 DOI: 10.1016/j.ajog.2010.08.054 - Direct visual control on cord coagulation using a fetoscopy-guided bipolar forceps. Description of a new technique.
Yamamoto M, Barki G, Ville Y.
Prenat Diagn. 2010 Feb, PMID: 20033924 DOI: 10.1002/pd.2419 - Profiling fetal cardiac function in twin-twin transfusion syndrome.
Stirnemann JJ, Mougeot M, Proulx F, Nasr B, Essaoui M, Fouron JC, Ville Y.
Ultrasound Obstet Gynecol. 2010 Jan, PMID: 20020467 DOI: 10.1002/uog.7488
2009
- Neurodevelopmental outcome at 2 years in children born preterm treated by amnioreduction or fetoscopic laser surgery for twin-to-twin transfusion syndrome: comparison with dichorionic twins.
Lenclen R, Ciarlo G, Paupe A, Bussieres L, Ville Y.
Am J Obstet Gynecol. 2009 Sep, PMID: 19608152 DOI: 10.1016/j.ajog.2009.05.036 - [Prenatal management of uncomplicated monochorionic biamniotic pregnancies].
Salomon LJ, Stirnemann J, Bernard JP, Essaoui M, Chalouhi G, El Sabbagh A, Ville Y.
J Gynecol Obstet Biol Reprod (Paris). 2009 Dec, PMID: 20141926 DOI: 10.1016/S0368-2315(09)73559-8
2008
- [Twin-to-twin transfusion syndrome: diagnosis and treatment].
Salomon LJ, Ville Y.
Bull Acad Natl Med. 2008 Nov, PMID: 19445374 - Pseudoamniotic band syndrome: a rare complication of monochorionic twins with fetofetal transfusion syndrome treated by laser coagulation.
Winer N, Salomon LJ, Essaoui M, Nasr B, Bernard JP, Ville Y.
Am J Obstet Gynecol. 2008 Apr, PMID: 18395033 DOI: 10.1016/j.ajog.2007.09.030 - Emergency cerclage in cases of twin-to-twin transfusion syndrome with a short cervix at the time of surgery and relationship to perinatal outcome.
Salomon LJ, Nasr B, Nizard J, Bernard JP, Essaoui M, Bussieres L, Ville Y.
Prenat Diagn. 2008 Dec;28(13):1256-61. doi: 10.1002/pd.2156. - Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto-fetal transfusion syndrome.
Quarello E, Stirnemann J, Nassar M, Nasr B, Bernard JP, Leleu-Huard F, Ville Y.
BJOG. 2008 Apr, PMID: 18333940 DOI: 10.1111/j.1471-0528.2007.01659.x - Update on twin-to-twin transfusion syndrome.
El Kateb A, Ville Y.
Best Pract Res Clin Obstet Gynaecol. 2008 Feb, PMID: 18262471 DOI: 10.1016/j.bpobgyn.2007.07.002 - A definition of selectivity in laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome and its relationship to perinatal outcome.
Stirnemann JJ, Nasr B, Quarello E, Ortqvist L, Nassar M, Bernard JP, Ville Y.
Am J Obstet Gynecol. 2008 Jan, PMID: 18166308 DOI: 10.1016/j.ajog.2007.06.009
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In a monochorionic pregnancy, where twins share the same placenta, an anomaly called feto-fetal transfusion syndrome can occur. What is this syndrome? How is it managed? We take a look at the situation with Pr Yves Ville, obstetrician-gynecologist and coordinator of the feto-fetal transfusion syndrome reference center at Necker hospital, Paris.
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2024 Annual Meeting
On July 1st, 2024, the first annual meeting of the CRMR took place at the Imagine Institute.
This event brought together healthcare professionals from various competence centers as well as representatives from associations.
During the meeting, collaborations on innovative research projects were presented. The day also included a Multidisciplinary Consultation Meeting to discuss center-specific cases, further strengthening cooperation and the exchange of best practices among the involved stakeholders.
Contact information
Necker-Enfants malades university Hospital
> Obstetrics department
149 rue de Sèvres
75743 PARIS Cedex 15
> Welcome Booklet – Adult Patients
In Necker, the reference center for rare placental pathologies in monochorionic pregnancies (PaRaDiGM) in brief …
* data valid for 2022