ObjectiveTo examine the relationship between the discordance in placental territory (PT), birthweight (BW), and vascular anastomoses in placentas from a prospective series of monochorionic diamniotic (MCDA) twins included in the 1st trimester.Study designCord vessels were injected with dyed barium sulphate. Rx angiograms and digital photographs of the chorionic surface were taken. BW discordance was defined as BW heavier/BW lighter twin. PT discordance was determined on Rx angiogram as the ratio of venous surface areas of the larger and smaller placental part. On the digital photograph, minimal diameters (mm) of arterio-arterial (AAs) and of each vein of an arterio-venous (AV) anastomosis were measured. An estimate of net AV transfusion was calculated as the difference of total diameters of AVs draining in either direction.Results76 placentas were analysed. BW discordance increased with PT discordance (P<0.0001). AA diameter (P<0.01) and net AV transfusion (P<0.001) towards the larger placental part increased with PT discordance. For a given PT discordance, BW discordance decreased with increasing AA diameter (P<0.01) and net AV transfusion towards the larger placental part (P<0.05).ConclusionUnequally shared placentas have larger AAs and a larger estimated net AV transfusion towards the larger placental part, as compared to equally shared placentas, which decreases BW discordance for a given PT discordance. Supported by European Commission-Eurotwin2twin - QLG1-CT-2002-01632. ObjectiveTo examine the relationship between the discordance in placental territory (PT), birthweight (BW), and vascular anastomoses in placentas from a prospective series of monochorionic diamniotic (MCDA) twins included in the 1st trimester. To examine the relationship between the discordance in placental territory (PT), birthweight (BW), and vascular anastomoses in placentas from a prospective series of monochorionic diamniotic (MCDA) twins included in the 1st trimester. Study designCord vessels were injected with dyed barium sulphate. Rx angiograms and digital photographs of the chorionic surface were taken. BW discordance was defined as BW heavier/BW lighter twin. PT discordance was determined on Rx angiogram as the ratio of venous surface areas of the larger and smaller placental part. On the digital photograph, minimal diameters (mm) of arterio-arterial (AAs) and of each vein of an arterio-venous (AV) anastomosis were measured. An estimate of net AV transfusion was calculated as the difference of total diameters of AVs draining in either direction. Cord vessels were injected with dyed barium sulphate. Rx angiograms and digital photographs of the chorionic surface were taken. BW discordance was defined as BW heavier/BW lighter twin. PT discordance was determined on Rx angiogram as the ratio of venous surface areas of the larger and smaller placental part. On the digital photograph, minimal diameters (mm) of arterio-arterial (AAs) and of each vein of an arterio-venous (AV) anastomosis were measured. An estimate of net AV transfusion was calculated as the difference of total diameters of AVs draining in either direction. Results76 placentas were analysed. BW discordance increased with PT discordance (P<0.0001). AA diameter (P<0.01) and net AV transfusion (P<0.001) towards the larger placental part increased with PT discordance. For a given PT discordance, BW discordance decreased with increasing AA diameter (P<0.01) and net AV transfusion towards the larger placental part (P<0.05). 76 placentas were analysed. BW discordance increased with PT discordance (P<0.0001). AA diameter (P<0.01) and net AV transfusion (P<0.001) towards the larger placental part increased with PT discordance. For a given PT discordance, BW discordance decreased with increasing AA diameter (P<0.01) and net AV transfusion towards the larger placental part (P<0.05). ConclusionUnequally shared placentas have larger AAs and a larger estimated net AV transfusion towards the larger placental part, as compared to equally shared placentas, which decreases BW discordance for a given PT discordance. Supported by European Commission-Eurotwin2twin - QLG1-CT-2002-01632. Unequally shared placentas have larger AAs and a larger estimated net AV transfusion towards the larger placental part, as compared to equally shared placentas, which decreases BW discordance for a given PT discordance. Supported by European Commission-Eurotwin2twin - QLG1-CT-2002-01632.