Fetal and neonatal brain lesions following laser ablation for twin‐to‐twin‐transfusion‐syndrome as detected by pre‐ and post‐natal brain imaging

Hochberg, Alyssa; Silber, Ronit; Avnet, H.; Rosen, Haim; Katorza, E.; Hoffmann, Chen; Mazkereth, Ram; Lipitz, Shlomo; Weisz, Boaz; Yinon, Yoav

doi:10.1002/pd.6061

Cited by 7 publications

(14 citation statements)

References 25 publications

(60 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unlike our study which showed no statistically significant differences in brain lesions detected on postnatal brain imaging between no post‐laser TAPS and post‐laser TAPS, a study by Stirnemann et al 32 . and Hochberg et al 33 . showed post‐laser TAPS to be a significant risk factor for brain lesions when compared to pregnancies with no detected brain lesions on imaging.…”

Section: Discussioncontrasting

confidence: 99%

“…In the literature, incidence of these outcomes varied widely among studies (ranging between 0% and 25% for severe cerebral injury), 5,7,12,30,31 mostly related to their small sample size and heterogenicity in the management options, with no specific predominance being shown among donors or recipients. Unlike our study which showed no statistically significant differences in brain lesions detected on postnatal brain imaging between no post-laser TAPS and post-laser TAPS, a study by Stirnemann et al 32 and Hochberg et al 33 showed post-laser TAPS to be a significant risk factor for brain lesions when compared to pregnancies with no detected brain lesions on imaging. This afterward.…”

Section: Discussioncontrasting

confidence: 99%

See 1 more Smart Citation

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

et al. 2022

View full text Add to dashboard Cite

Objective To investigate whether the presence of twin‐anemia polycythemia sequence (TAPS) with twin‐to‐twin transfusion syndrome (TTTS) or post‐laser TAPS would change outcomes using different TAPS diagnostic criteria. Methods TTTS cases undergoing laser surgery between 2012 and 2020 were included. Groups included pre‐laser TTTS‐only compared to TTTS + TAPS, and no post‐laser TAPS compared to post‐laser TAPS. Three prenatal TAPS diagnostic criteria were used: group A: middle cerebral artery‐peak systolic velocity (MCA‐PSV) > 1.5 MoM in one twin and <1 MoM in the other twin, group B: inter‐twin MCA‐PSV difference >1 MoM, and group C: inter‐twin MCA‐PSV difference >0.5 MoM. Perinatal outcomes including survival and severe cerebral injury were investigated. Results 174 laser procedures were included. TTTS + TAPS cases were 16 in group A, 17 in group B, and 29 in group C. Post‐laser TAPS cases were 11 in group A, 6 in group B, and 12 in group C. There were no differences in preoperative, operative variables and outcomes including survival and severe cerebral injury between groups using all three TAPS diagnostic criteria. The incidence of TTTS + TAPS was highest in group C (16.7%), then group B (9.8%), followed by group A (9.2%). The incidence of post‐laser TAPS was highest in group C (9%), then group A (8.3%), followed by group B (4.5%). Conclusion Presence of TAPS complicating TTTS and presence of post‐laser TAPS do not seem to be associated with worse perinatal outcomes including postnatal‐ultrasound detected cerebral injury using three different TAPS criteria. Collaborative studies are needed to investigate the validity and the performance of different TAPS criteria.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Incorporation of prenatal MR brain imaging proved beneficial allowing important additional diagnosis of injuries undetected by neurosonogram scans performed by experienced specialists. In line with the findings of the current study, we and others have previously reported that post‐laser TAPS is a risk factor for fetal brain injury in survivors of laser ablation for TTTS 19,20 …”

Section: Discussionsupporting

confidence: 92%

“…In line with the findings of the current study, we and others have previously reported that post-laser TAPS is a risk factor for fetal brain injury in survivors of laser ablation for TTTS. 19,20 In our study, we were not able to identify specific risk factors subjecting TAPS fetuses to pre-or post-natal brain injury findings.…”

Section: Variablementioning

confidence: 59%

Fetal and neonatal brain injury in twins complicated by twin anemia polycythemia sequence

et al. 2022

Self Cite

View full text Add to dashboard Cite

Objectives To determine the rate of fetal and neonatal brain lesions and define risk factors for such lesions in pregnancies complicated by Twin Anemia Polycythemia Sequence (TAPS). Methods A retrospective cohort study of monochorionic twin pregnancies which were diagnosed with TAPS in a single tertiary medical center between 2013 and 2021. Pregnancies were followed with fetal brain neurosonogram every 2 weeks and fetal brain MRI (magnetic resonance imaging) was performed when indicated at 28–32 weeks of gestation; post‐natal brain imaging included neonatal brain ultrasound. Pregnancies with pre‐ and post‐natal brain lesions were compared to those without such findings. Results Overall, 23 monochorionic diamniotic pregnancies were diagnosed with TAPS over the study period resulting in perinatal survival of 91.3% (42/46). In 6/23 (26%) pregnancies and 7/46 (15.2%) fetuses pre‐ or post‐natal brain lesions were detected, of whom five were the polycythemic twins and two were the anemic twins. Brain findings included intra‐cerebral hemorrhage and ischemic lesions and were diagnosed prenatally in 6/7 (85.7%) cases. No risk factors for severe brain lesions were identified. Conclusions TAPS may place the fetuses and neonates at increased risk for cerebral injuries. Incorporation of fetal brain imaging protocols may enhance precise prenatal diagnosis and allow for accurate parental counseling and post‐natal care.

show abstract

“…Inconsistency in the definition of abnormal imaging findings such as mild ventriculomegaly or nonconclusive MR imaging findings such as suspected subependymal blood products are another reason for the incidence variability. 20 Early fbMRI, performed acutely (,2 weeks) following sIUFD or when postprocedural complications are noted, might also increase the sensitivity for diagnosing acute ischemia or hemorrhage, especially when DWI is performed. 19 Early ischemic or hemorrhagic findings may spontaneously resolve and may not be detected later in pregnancy and at the time of third trimester follow-up.…”

Section: Discussionmentioning

confidence: 99%

Third Trimester Structural and Diffusion Brain Imaging after Single Intrauterine Fetal Death in Monochorionic Twins: MRI-Based Cohort Study

Segev

Djurabayev

Hadi³

et al. 2022

AJNR Am J Neuroradiol

Self Cite

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Single intrauterine fetal death increases the risk of antenatal brain lesions in the surviving twin. We evaluated the prevalence of structural brain lesions, biometry, and diffusivity on routine third trimester MR imaging performed following single intrauterine fetal death. MATERIALS AND METHODS:In a retrospective MR imaging-based cohort study, we compared 29 monochorionic twins complicated with single intrauterine fetal death (14 following laser ablation treatment for twin-to-twin transfusion syndrome, 8 following selective fetal reduction, and 7 spontaneous) with 2 control cohorts (49 singleton fetuses and 28 uncomplicated twin fetuses). All fetuses in the single intrauterine fetal death group underwent fetal brain MR imaging as a routine third trimester evaluation. Structural brain lesions were analyzed. Cerebral biometry and diffusivity were measured and compared.RESULTS: Brain lesions consistent with the evolution of prior ischemic injury were found in 1 of 29 fetuses, not detected by ultrasound. No acute brain infarction, hemorrhage, or cortical abnormalities were found. Supratentorial biometric measurements in the single intrauterine fetal death group were significantly smaller than those in the singleton group, but not significantly different from those in the uncomplicated twin group. There were no significant differences in ADC values of the cerebral hemispheres, basal ganglia, and pons between the single intrauterine fetal death group and either control group.CONCLUSIONS: Although smaller brain biometry was found, normal diffusivity in surviving twins suggests normal parenchymal microstructure. The rate of cerebral structural injury was relatively low in our cohort, arguing against the routine use of fetal brain MR imaging in twin pregnancies complicated with single intrauterine fetal death. Larger prospective studies are necessary to guide appropriate surveillance protocol and parental counseling in twin pregnancies complicated by single intrauterine fetal death.

show abstract

Fetal and neonatal brain lesions following laser ablation for twin‐to‐twin‐transfusion‐syndrome as detected by pre‐ and post‐natal brain imaging

Cited by 7 publications

References 25 publications

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

Perinatal outcomes of pregnancies with twin‐anemia polycythemia sequence complicating twin‐to‐twin transfusion syndrome using different twin‐anemia polycythemia sequence diagnostic criteria

Fetal and neonatal brain injury in twins complicated by twin anemia polycythemia sequence

Third Trimester Structural and Diffusion Brain Imaging after Single Intrauterine Fetal Death in Monochorionic Twins: MRI-Based Cohort Study

Contact Info

Product

Resources

About