Fetal and Neonatal Outcomes in Twin Oligohydramnios-Polyhydramnios Sequence Including Cerebral Palsy

Abstract

Objective: The purpose of this study was to review consecutive pregnancies complicated by twin oligohydramnios-polyhydramnios sequence (TOPS) and to clarify the probable factors influencing the perinatal outcomes. Methods: Twenty-five pregnancies with a diagnosis of TOPS were treated with and without amniocentesis. A poor perinatal outcome was defined when either perinatal mortality or cerebral palsy was observed. Results: The mean gestational age at the time of diagnosis and of delivery was 27.8 (range 21–34) and 30.7 (range 23–35) weeks, respectively. Tocolytic therapy and therapeutic amniocentesis were done in 16 (64%) and 13 (52%) cases. Hydrops fetalis was present in 10 cases. The survival rate was 72%, and cerebral palsy was diagnosed in 8 of 36 infants (22%). The poor prognostic factors were gestational age at delivery (<30 weeks) and presence of symptomatic preterm labor and hydrops fetalis. Therapeutic amniocentesis did not influence the perinatal outcome. Conclusions: In this observational study, the long-term as well as the short-term perinatal outcome of pregnancy with TOPS seems to be poor. In addition, therapeutic amniocentesis in TOPS does not appear to affect fetal and neonatal outcomes.

Neurodevelopmental Outcome Following Congenital Cytomegalovirus Infection in Preterm Infants with Twin-to-Twin Transfusion Syndrome: A Case Report

“…Among other factors infl ammation / infection, hypoxia / hyperoxia and ischemia are known to play a critical role in the process of preterm brain injury [2] . In the presented case several factors might have contributed to the severity of brain injury in both infants: i) twin pregnancies per se show an increased risk for cerebral palsy and neurodevelopmental delay compared to singleton births [12] ; ii) TTTS shows a further elevated risk for disability, that is even higher for preterm infants born before 30 weeks gestational age [7] ; iii) fetal CMV infection in early pregnancy (1 st and 2 nd trimester) can have a teratogenic potential and may result in growth restriction and disturbances in brain development mainly aff ecting cell migration and myelinization [6] .…”

“…Neurologische Entwicklung nach Fr ü hgeburtlichkeit, kongenitaler CMV-Infektion und feto-fetalem Transfusionssyndrom -ein Fallbericht rebral injury presents amongst others with intraparenchymal echodensities, ventriculomegaly, calcifi cations and delayed myelination [7] . Here we report preterm born twins who presented with twin-to-twin transfusion syndrome and congenital CMV infection.…”

Multiple Pregnancies

“…The fetus papyraceus was in a separate mass at left zygosity, ART and chorionicity can be individually determined for their individual relevance to the origin of CP in multiples (Blickstein 2004 ) .There is little doubt that MZ twins have a greater frequency of cerebral impairment when one fetus dies in utero. Numerous studies attest to this; Pharoah ( 2001 ) Cincotta et al ( 2000 ) merely called for further study of this relationship; Matsuda and Kouno ( 2002 ) found a 22% incidence of cerebral palsy in TTTS; Resch et al ( 2004 ) identi fi ed hypocarbia in premature babies as the principal risk factor; Lopriore et al ( 2006b ) found 14% of twins after laser ablations for severe TTTS to suffer impaired CNS status; Rossi and D'Addario ( 2009b ) found no difference in CNS impairment of donors (9%) and recipients (10%) of the TTTS; Jelin et al ( 2008 ) described that antenatal MRI examination identi fi ed CNS abnormalities in 7 of 21 cases with antenatal demise of one twin; Zach et al ( 2007 ) found 25% of CNS injuries after fetal demise. Other investigators have weighed in on the possible neurodevelopmental sequelae of TTTS.…”