The role of the absence of Hyrtl’s anastomosis in monochorionic pregnancy: friend or foe?

Abstract Background: Hyrtl’s anastomosis, an intra-arterial shunt, plays a protective role when the placental territories supplied by the umbilical arteries are different in size. Its absence is associated with an increased risk of poor outcomes in singleton pregnancy. However, the literature and studies on the effect of absent Hyrtl’s anastomosis in twin placentas are rare. Case Presentation: We present a case of a monochorionic diamniotic(MCDA) twin pregnancy complicated with type I selective fetal growth restriction(SFGR). Despite discordance in placental territory and cord insertion sites, the patient had an overall good pregnancy process, suggesting that the absence of Hyrtl’s anastomosis may have played a benign role. Conclusions: The absence of Hyrtl’s anastomosis in our case seemed to show a favorable effect, representing a finding of opposite effects in monochorionic placentas compared with singleton placentas.