ULTRASOUND Messages for May, 2002: Re: Placentation was

Re: Placentation was - FW: ULTRASOUND digest 1595
From: DuBose, Terry (DuboseTerryJ@uams.edu)
Mon May 13 09:05:11 2002

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Dear Dr. Benirschke, thanks for this very clear and concise answer. This has been discussed on the Ultrasound forum before... however, I have always believed as you have stated the case. Thank you for your time.
Peace, Terry J. DuBose, M.S., RDMS Assistant Professor & Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.io.com/~dubose/ <http://www.io.com/~dubose/> http://www.uams.edu/CHRP/dmshome.htm <http://www.uams.edu/CHRP/dmshome.htm> http://www.obgyn.net/us/panel/panel.htm <http://www.obgyn.net/us/panel/panel.htm>
-----Original Message----- From: Kurt Benirschke [mailto:kbenirsc@ucsd.edu] Sent: Sunday, May 12, 2002 9:54 AM To: DuBose, Terry Subject: Re: Placentation was - FW: ULTRASOUND digest 1595
Placental "migration" properly speaking, of course is not possible. The term trophotropism was coined to understand placentation in previas. And subsequently, when previas were frequently seen sonographically in early gestation but subsequently "disappeared", this led to the concept of placenta atrophy (not migration). This correlates with more marginal cord insertion, is also the mechanism of abnormal cords in multiple gestation. thus, true "migration" does not happen (the placenta can't pack up and move, so to speak. It atrophies and correspondingly hypertrophies more laterally. It is possible that there is some differential growth of the uterine wall as well, although that is much more difficult to prove and for me also more difficult to conceive mechanistically.--I hope this answers you question.--I am late in reply, as I was away for a week attending meetings in Europe - sorry! KB>
At 09:06 AM 5/9/2002 -0500, you wrote:
Dear Dr. Benirschke, I found your response to Dr. Moroder below very interesting. Looking at your web page and the glossary I did not find any discussion of "placental migration". Your thoughts on this phenomena as to the mechanism, whether differential uterine wall growth, trophotrophoism, as suggest by Dr. Harris Finberg, or a combination of the two would be very welcome on this forum.
Thanks for your time and interest.
Peace, Terry J. DuBose, M.S., RDMS Assistant Professor & Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.io.com/~dubose/ http://www.uams.edu/CHRP/dmshome.htm http://www.obgyn.net/us/panel/panel.htm
-----Original Message----- From: James S Smeltzer MD [mailto:gaperina@mindspring.com] Sent: Wednesday, May 08, 2002 10:40 PM To: Multiple recipients of list ULTRASOUND Subject: Re: ULTRASOUND digest 1595
Although Dr. Benirshke has the last word on placentation and I have heard of a Turners/Male twin discordant sex mosaic, I would think Klinefelter's and normal female would be more frequent as Turner's is usually lethal in the embryonic/fetal period. A DNA fingerprint will show unusual homology if this is the case.
Jim Smeltzer
At 02:36 PM 5/7/2002 -0500, you wrote: >This might be a case which might give you some clues for your question
>and I 'd like to share it with you.
>Since I was quite puzzled from a case of monochorionic twins I thought
>of writing to Prof Bernischke and asked his opinion. I scanned a
>patient at 8+4 weeks with the following findings: two amniotic sacs, two
>yalk sacs in a common extracelomic space. I actually used the pictures
>to demonstrate a monochorionic pregnancy in a couple of talks I
>gave on early scanning in twin pregnancy: I thought that these findings
>are proof of a monochorionic that means also monozygotic twin pregnancy.
>You cannot imagine my surprise when at 20 weeks I found that the twins
>were incontrovertibly discordant for the gender.
>What is the biological explanation for that? Is it possible that
>identical twins are only discordant in the phenotypus? Do dizygotic
>twins have only one
>extracelomic space?
>Answer:
>
>Dear Dr. Moroder:
>This set of twins is VERY unusual, as you correctly interpreted. The
>fact that they are of different gender is perhaps significant, but not
>necessarily
>PROOF that they are dizygotic. There are numerous cases described where
>a set of monozygotic twins were discordant for sex chromosome, where one
>baby is 46XY, the other 45XO. During early embryogenesis a Y-chromosome
>got lost and the other twin develops as a Turner's syndrome. When they
>are monochorionic, they often then also have blood chimerism, but that
>does not always happen. That is the first possibility - socalled
>heterokaryotypic
>twins (p. 846 in my book:Pathology of Human Placenta, Springer-Verlag,
>2000, 4th edition).
>But it is also true that VERY few dizygotic twins developed in a single
>chorionic sac and result then in blood chimerism. In fact, a rare case
>has even
>developed the transfusion syndrome, but only 4-5 cases are known to me
>that can be seen to be PROVEN. In fact, the first good case (color
>picture in
>the first edition of my book) was from Cameron in England and he
>subsequently showed that the twins (dichorionic though they were and
>chimeric)
>had been identical twins with anastomosis.
>I recommend that you wait until the twins are born and do karyotypes on
>them. I would be inclined to anticipate Turner in one.
>I hope this clarifies the situation.
>You should know though that in marmoset monkeys this is the REGULKAR
>mode of placentation and it occurs in cattle and a few other ungulates
>as
>well.
>Mit besten Gruessen, K. Benirschke
>
>Kurt Benirschke, M.D.
>Home: 8457 Prestwick Drive, La Jolla, CA 92037 Tel: 858-459-9132. FAX:
>858-459-1063.
>Office: UCSD Medical Center, 200 West Arbor Drive, San Diego, CA
>92103-8321. Tel.: 619-543-2618; Office(Agnes):619-543-5719. Fax:
>619-543-7711.e-mail: kbenirsc@ucsd.edu
>Please visit my Website on Comparative Placentation at:
> http://medicine.ucsd.edu/CPA <http://medicine.ucsd.edu/CPA>
>
>At Tue, 7 May 2002, Regnifob@aol.com wrote:
>>
>>A not so esoteric question
>>
>>An ultrasound may detect a gender which does not jibe with that on a CVS
thus >>raising a flag to an error in the CVS. Are requests often made to
>>ultrasonographers to specifically use this as a sort of back up to the CVS
>>result when the chromosme result is identical to the mother's and could
>>indicate unsuspected maternal contamination with no other clues?
>>
>>Dr. Bofinger from Cincinnati
>
>--
>Wolfgang Moroder, MD
>Prenatal Unit
>Bolzano General Hospital Italy
>

Kurt Benirschke, M.D. Department of Pathology UCSD Medical Center 200 West Arbor Drive San Diego, CA 92103-8321 e:mail kbenirsc@ucsd.edu Tel. 619-543-2618 FAX 619-543-7711 Please visit my Website on Comparative Placentation http://medicine.ucsd.edu/cpa <http://medicine.ucsd.edu/cpa>

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