Brain Damage in Monozygous Twins

Abstract

A series of 15 monochorionic twins with a great variety of cerebral lesions is reported. Seven cases illustrate the classical situation: the recipient twin was affected and his co-twin, the donor was macerated. In 5 cases, the lesions were described in the donor twin as well and once, as early as 22 weeks. The lesions were usually hypoxic-ischemic, in 2 they were hemorrhagic. In 1 case there was a malformation. Fetal US were performed in 11 cases and the diagnosis of either IUGR, death of a fetus and/or brain lesions in the survivor could be made in 10 cases and once as early as 21 weeks. In fetuses born alive, transfontanellar US or CT scan have confirmed the diagnosis made on fetal US. The pathogenesis of the lesions is not fully understood. Lesions in the recipient twin may result from emboli or thromboplastic material originating from the macerated co-twin. We suggest that blood pressure instability or episodes of severe hypotension might as well lead to brain and/or visceral lesions in the recipient twin. In the donor, the lesions result from hypotension and/or anemia. With improvement and generalization of imaging techniques, the vitality of the fetuses as well as biometric parameters and anatomical structures will be better controlled. However, in case of a fetal death, occurrence of lesions in the survivor is unpredictable and no uniform policy has been proposed yet. Studies with Doppler and continuous monitoring of funicular circulation should improve our knowledge on feto-fetal transfusion and permit to detect hemodynamic fluctuation or impairment.

Twin foetus papyraceous in triplet pregnancy

“…[15][16][17] Foetal death could also be a result of congenital malformations, umbilical cord prolapse or hydrops. 9 The survivor in this triplet pregnancy had no obvious complications.…”

Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto‐fetal transfusion syndrome

“…17 These complications are mainly due to acute and profound exsanguination of the live fetus into its dead co-twin and its placenta across placental vascular anastomoses at around the time of death. [5][6][7][8] The consequences of the death of one MC twin are probably related to angioarchitectural features of the MC placenta. Around 15% of MC pregnancies develop FFTS; 18 however, the exsanguination phenomenon can also develop in the absence of FFTS.…”

“…2 The IUD of one twin may cause several complications in the survivor. Two theories have been proposed in the early sixties and through to the nineties by Benirschke, 3 Bendon 4 and Larroche 5 to explain the pathogenesis of the lesions found in the survivors. The embolisation theory to explain visceral infarcts and lesions of necrosis in single survivors has remained speculative 3 and does not account for the fact that similar lesions can also occur when both twins are born alive.…”

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

“…Although urgent cesarean section was performed, the donor twin had cerebral palsy, whereas the outcome of the other (recipient) twin was normal. Larroche et al [21] mentioned that cerebral ischemia resulted from hypotension and/or anemia in the donor twin, whereas it resulted from blood pressure instability and episodes of severe hypotension in the recipient twin. As seen in a surviving twin after intrauterine fetal demise of 1 twin, hemodynamic imbalance to cause cerebral ischemia might occur in such cases; however, the exact mechanism is still unknown.…”