Natural History of Twin Gestation Complicated by in utero Fetal Demise: Associations of Chorionicity, Prematurity, and Maternal Morbidity

Kaufman, Howard K.; Hume, Roderick F.; Calhoun, Byron C.; Carlson, Nancy A.; Yorke, Victoria; Elliott, Dawn; Evans, Mark I.

doi:10.1159/000073140

Cited by 22 publications

(8 citation statements)

References 16 publications

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“…Whether the same findings would occur in monozygotic twins, especially monochorionic twins with a significantly higher risk of fetal demise is unclear. 33,34 Moreover, the results from the reduced trisomy cotwin might not fully represent the natural demise of a cotwin, which can be caused by many other reasons with or without the presence of chromosomal abnormalities. 7,35 Last, because of logistical difficulties during clinical practice, the time points of sample collection from each woman were not identical.…”

Section: Discussionmentioning

confidence: 99%

Temporal persistence of residual fetal cell‐free DNA from a deceased cotwin after selective fetal reduction in dichorionic diamniotic twin pregnancies

Chen

Wang

et al. 2021

Prenatal Diagnosis

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Objectives: To determine the temporal persistence of the residual cell-free DNA (cfDNA) of the deceased cotwin in maternal circulation after selective fetal reduction and evaluate its long persistence in noninvasive prenatal testing (NIPT).Methods: Dichorionic diamniotic twins (N ¼ 5) undergoing selective fetal reduction because of a trisomy were recruited. After informed consent, maternal blood was collected immediately before reduction and periodically after reduction until birth.The plasma cfDNA of each sample was sequenced and analyzed for fetal aneuploidy and fetal fractions.Results: In all pregnancies, the fetal fraction of the cfDNA of the deceased fetus increased to peak at 7-9 weeks after fetal reduction, and subsequently decreased gradually to almost undetectable during the late third trimester. The NIPT T-scores persistently reflected the detection of fetal trisomy up to 16 (median 9.5) weeks after fetal reduction. Conclusions:Residual cfDNA from the deceased cotwin after selective reduction at 14-17 gestational weeks led to the persistent generation of false-positive NIPT results for up to 16 weeks postdemise. Thus, providing NIPT for pregnancies with a cotwin demise in early second trimester is prone to misleading results and not recommended. Key PointsWhat's already known about this topic? � The estimated prevalence of a cotwin's fetal demise in all twin pregnancies is 6.2%, although the prevalence might be underestimated. The deceased fetus releases residual cell-free DNA (cfDNA) to the maternal circulation, leading to false-positive findings of fetal aneuploidy on noninvasive prenatal testing (NIPT). However, the evidence is still needed to determine the implications of longitudinal residual cfDNA for NIPT use.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Discussionmentioning

confidence: 99%

Temporal persistence of residual fetal cell‐free DNA from a deceased cotwin after selective fetal reduction in dichorionic diamniotic twin pregnancies

Chen

Wang

et al. 2021

Prenatal Diagnosis

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“…Debido a que los neonatos prematuros son susceptibles a complicaciones neurológicas y el gemelo superviviente puede estar normal, la experiencia sugiere la no-intervención, ya que la prematuridad-peso bajo al nacer pueden superponer un daño potencial (10,22) .…”

Section: Muerte Fetal Intrauterina Por Edad Gestacionalunclassified

“…La prevalencia de MFIUG en gemelos dicorió-nicos es menor que en gemelos monocorióni-cos (10,38) . No se deben realizar intervenciones inmediatas en gemelos dicoriónicos, ya que no se asocian a complicaciones fetales y el riesgo para el gemelo superviviente es mínimo.…”

Section: Muerte Fetal Intrauterina Por Corionicidadunclassified

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Muerte fetal intrauterina de uno de los gemelos

Rondón-Tapia

2018

Rev peru ginecol obstet.

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RESUMENLos embarazos múltiples, la mayoría de los cuales son gemelares, tienen un riesgo sustancialmente mayor de morbimortalidad fetal comparado con los embarazos únicos. La muerte fetal de uno de los gemelos en embarazos gemelares monocoriónicos es más frecuente que en embarazos gemelares dicoriónicos. La muerte fetal intrauterina ocurre en 1 a 7% de todos los embarazos gemelares y aumenta considerablemente la tasa de complicaciones del gemelo superviviente, incluyendo pérdida fetal, parto prematuro y daño de órgano final. La edad gestacional en que ocurre la muerte fetal intrauterina y la corionicidad de los embarazos múltiples son los dos factores más importantes al considerar los riesgos del gemelo superviviente. La morbimortalidad de estos embarazos puede disminuir con la identificación del embarazo de riesgo y la vigilancia prenatal intensiva. Los embarazos monocoriónicos son más difíciles de manejar y a menudo los embarazos se interrumpen entre las 34 y 36 semanas. Los embarazos dicoriónicos se pueden interrumpir más cerca del término. Palabras clave. Muerte intrauterina de un gemelo, Muerte fetal intrauterina, Embarazo gemelar. ABSTRACTMultiple pregnancies, most of which are twins, have a substantially increased risk of fetal morbidity and mortality compared to single pregnancies. The fetal death of one of the twins in monochorionic twin pregnancies is more frequent than in twin dichorionic pregnancies. Intrauterine fetal death occurs in 1-7% of all twin pregnancies and greatly increases the rate of complications of the surviving twin including fetal loss, preterm birth, and end organ damage. The gestational age at which intrauterine fetal death occurs and the chorionicity of the multiple pregnancy are the two most important factors when considering the risks of the surviving twin. The morbidity and mortality of these pregnancies may decrease with risk identification and intensive prenatal surveillance. Monochorionic pregnancies are more difficult to manage, and often pregnancies are interrupted at 34-36 weeks. Dichorionic pregnancies can be interrupted closer to term.

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“…При такой тактике ведения необхо-димо тщательное мониторирование состояния беременной (еженедельное клинико-лаборатор-ное обследование, контроль артериального дав-ления, отеков, температуры тела, характера вы-делений). Учитывая риск коагулопатических нарушений, который увеличивается через 4 не-дели после гибели плода [30], в случае выявле-ния патологии необходим ежедневный контроль свертывающей системы крови. Мониторинг со-стояния плода включает в себя допплерометрию (при дихориальной двойне -каждую неделю, при монохориальной -2 раза в неделю), биометрию каждые 2 недели, эхографию головного мозга плода для выявления энцефаломаляции (при монохориальной двойне) еженедельно.…”

Section: альманах клинической медицины 2015 март; 37: 32-40unclassified