Antenatal origin of neurologic damage in newborn infants. II. Multiple gestations

Low Rate of Cerebral Injury in Monochorionic Twins With Selective Intrauterine Growth Restriction

“…The majority (13/14, 92.9%) of the minor scan anomalies; however, were only transient without clinical significance. In a study of monochorionic diamniotic twins without TTTS (Cordero et al, 2005), it was concluded that monochorionic diamniotic twins had high rates of birthweight discordance, fetal growth restriction, fetal distress, prematurity and cesarean delivery, but their perinatal mortality was low; in the report, the incidence of grade III and IV IVH was 3% and PVL was 1% in the birthweight discordant group, a finding coinciding with our study results that the severe cerebral injury rate in MC with sIUGR was not as high as previously reported (Adegbite et al, 2005;Bejar et al, 1990). In a recent report by Lopriore et al (2008), who also found a low incidence of cerebral injury in MC with sIUGR (or discordant weight), they suspected one of the reasons for the low incidence was a relatively longer gestational age at delivery, 34 weeks in their case series.…”

“…The neurological outcome of MC twins with sIUGR has been reported to be poor (Adegbite et al, 2005;Bejar et al, 1990) or fair (Lopriore et al, 2008). What's even worse, MC with sIUGR with abnormal umbilical artery (UA) Doppler (defined as absence of reverse of end-diastolic velocity) of the IUGR twin could mean more neonatal death and intrauterine fetal demise (Chang et al, 2008;Gratacos et al, 2007;Russell et al, 2007).…”

Survivor of Co-Twin Following Intrauterine Demise of One Fetus

“…MCDA twins are considered high risk by virtue of their 3-to 5-fold increased perinatal morbidity and mortality compared to dichorionic (DC) twins. This is largely attributed to twin-twin transfusion syndrome (TTTS), which occurs in 15%-20% of MCDA twin pregnancies, and discordant intrauterine growth restriction (IUGR), which complicates an additional 25% [1,[6][7][8][9]. The situation is entirely different in dichorionic pregnancies, in which remaining twin will be spared following death of its co-twin [10].…”

Causal Hypothesis for Some Congenital Anomalies

“…In the earliest reports, the ischemic damage was attributed to the transfer of thromboplastic material leading to disseminated intravascular coagulation or thromboemboli from the dead to the surviving twin (Bejar et al, 1990;Benirschke, 1961;Moore et al, 1969). However, neither thromboembolism nor disseminated intravascular coagulation has often been demonstrated in these cases.…”