Fetal brain injury in survivors of twin pregnancies complicated by demise of one twin as assessed by<i>in utero</i>MR imaging

Griffiths, Paul D.; Sharrack, S.; Chan, Kkl; Bamfo, Jacqueline; Williams, F.T.; Kilby, Mark D.

doi:10.1002/pd.4577

Cited by 33 publications

(29 citation statements)

References 19 publications

(34 reference statements)

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“…The survival rate of the cotwin is approximately 80% and the risk of premature rupture of the membranes and preterm birth prior to 32 weeks is 20%. The risk of adverse neurological sequelae in the surviving cotwin may also be increased compared with that in uncomplicated pregnancy ( EVIDENCE LEVEL: 2++ ).…”

Section: Recommendationsmentioning

confidence: 99%

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy

Khalil¹,

Rodgers²,

Baschat³

et al. 2016

Ultrasound Obstet Gynecol

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479

584

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Section: Recommendationsmentioning

confidence: 99%

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy

Khalil¹,

Rodgers²,

Baschat³

et al. 2016

Ultrasound Obstet Gynecol

Self Cite

479

584

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“…25,26 Intrauterine demise of a monochorionic twin may result in severe ischaemic injury and extensive ICH in the surviving twin. 27,28 Maternal infections can seem mild yet have significant consequences for the fetus. An example of this is primary cytomegalovirus infection which can cause intracranial bleeding as well as the more frequently encountered migrational disorders, brain destruction and calcification.…”

Section: Aetiologymentioning

confidence: 99%

Findings and differential diagnosis of fetal intracranial haemorrhage and fetal ischaemic brain injury: what is the role of fetal MRI?

Putbrese¹,

Kennedy²

2016

The British Journal of Radiology

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Ventriculomegaly (VM) is a non-specific finding on fetal imaging. Identification of the specific aetiology is important, as it affects prognosis and may even change the course of current or future pregnancies. In this review, we will focus on the application of fetal MRI to demonstrate intracranial haemorrhage and ischaemic brain injury as opposed to other causes of VM. MRI is able to identify the specific aetiology of VM with much more sensitivity and specificity than ultrasound and should be considered whenever VM is identified on obstetric ultrasound. Advances in both fetal and neonatal MRI have the potential to shed further light on mechanisms of brain injury and the impact of chronic hypoxia; such information may guide future interventions.

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“…The other contra-indications to MRI in non-pregnant patients still apply in pregnancy: the presence of metallic foreign objects in the body and severe claustrophobia. Even if it is possible to obtain a high-quality fetal MRI, the radiological abnormalities detected do not necessarily equate to clinical neurodevelopmental signs, which is a particular problem in the case of non-progressive ventriculomegaly (Griffiths et al, 2015). Consequently, there are concerns that the use of fetal MRI may result in over diagnosis of neurological comorbidity.…”

Section: Antenatal Mode Of Imagingmentioning

confidence: 99%

“…Consequently, ultrasound may be used as a triage tool, and those with an abnormal ultrasound will then be offered a fetal MRI. However, Griffiths et al (2015) found that 6/9 cases of brain injury in co-twin survivors of sIUFD diagnosed on fetal MRI were missed on antenatal ultrasound and subsequently recommend antenatal MRI in all cases of sIUFD, which is now routine practice by many fetal medicine units, irrespective of the cause of the sIUFD. Doppler studies may also provide additional information as they can detect fetal anemia, especially the MCA peak systolic velocity.…”

Section: Antenatal Mode Of Imagingmentioning

confidence: 99%

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Fetal Brain Injury in Survivors of Twin Pregnancies Complicated by Demise of One Twin: A Review

2016

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Perinatal mortality is increased considerably in multiple pregnancies compared to singleton pregnancies, with single intrauterine fetal demise (sIUFD) presenting a rare but unique perinatal problem. Monochorionic pregnancies are at particular risk of sIUFD due to bidirectional inter-twin placental vascular anastomoses. The resulting inter-twin blood flow can become unbalanced, causing acute and chronic inter-twin transfusion and profound anemia secondary to fetal exsanguination into the low-pressure circulation of the dead fetus. If the sIUFD occurs after 14 weeks' gestation it is believed to have the most significant effect on the continuing pregnancy as the co-twin is at increased risk of preterm delivery, long-term neurological complications, and death. This article will focus on fetal brain injury in the surviving co-twin in the case of sIUFD, as it is the most common kind of injury in sIUFD, and one which concerns parents and may be the basis for terminating the pregnancy. We will outline how these brain injuries are thought to occur and describe potential pathophysiological mechanisms. We will discuss risk factors for brain injury in cases of sIUFD, including: chorionicity, cause of the sIUFD (spontaneous or secondary to an underlying pathological process such as twin-to-twin transfusion syndrome), gestation of delivery and how to prevent brain injury in the co-twin. We also review modes of imaging, discuss the difficulties in predicting the long-term outcome for co-twin survivors, and highlight the dearth of research in this area.

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Fetal brain injury in survivors of twin pregnancies complicated by demise of one twin as assessed byin uteroMR imaging

Cited by 33 publications

References 19 publications

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy

Findings and differential diagnosis of fetal intracranial haemorrhage and fetal ischaemic brain injury: what is the role of fetal MRI?

Fetal Brain Injury in Survivors of Twin Pregnancies Complicated by Demise of One Twin: A Review

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