Cerebral Lesions at Fetal Magnetic Resonance Imaging and Neurologic Outcome After Single Fetal Death in Monochorionic Twins

Abstract

Background: Single fetal death (sFD) in monochorionic twin pregnancies is associated with substantial morbidity and mortality in the survivor. The aim of our study was to evaluate the rate of cerebral lesions detected at fetal Magnetic Resonance Imaging (MRI) and to correlate the results with the neurologic outcome of the survivors of monochorionic twin pregnancies after sFD. Methods: Between 2005 and 2012, 11 monochorionic twin pregnancies with sFD and subsequent fetal MRI of the survivor were included. All neonates underwent neurologic assessment after birth and 56% of surviving infants underwent long-term neurologic assessment. MRI findings and neurologic outcome of the survivors were evaluated. Results: Gestational age at sFD was 20.9 (±2.9) weeks; 55% (6/11) of survivors of monochorionic twin pregnancies after sFD showed cerebral lesions at fetal MRI; 72% (8/11) of all survivors had normal neonatal neurologic outcome: all survivors with normal fetal MRI and 50% of survivors with cerebral lesions at fetal MRI. Longterm neurologic assessment was normal in all tested patients with normal fetal MRI and in one of three tested patients with cerebral lesions at fetal MRI. Conclusion: Survivors of monochorionic twin pregnancies after sFD show a high rate of cerebral lesions at fetal MRI. The importance of cerebral lesions at fetal MRI in survivors after sFD in monochorionic twin pregnancies is uncertain. All tested survivors with normal fetal MRI showed normal neurologic outcome but only one of three survivors with cerebral lesions at fetal MRI showed normal long-term neurologic outcome.

Influence of chorionicity and gestational age at single fetal loss on risk of preterm birth in twin pregnancy: analysis of STORK multiple pregnancy cohort

“…Optimal gestational age at delivery in the case of sIUD occurring in the second or third trimester has not yet been determined and the majority of these pregnancies are currently delivered within a few weeks following sIUD because of clinicians' concern. However, it should be borne in mind that immediate delivery after sIUD has not been proven to reduce the burden of the associated neonatal morbidity, while it exposes the surviving cotwin to the risks associated with prematurity.…”

Fetal brain injury in complicated monochorionic pregnancies: diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling

“…Assessment of the relationship between specific types of brain abnormalities demonstrated on pMRI and post‐natal and clinical outcome is required to inform parental counselling. Jatzko et al . have examined this in 11 survivors of spontaneous CD and found that three of six survivors with prenatally diagnosed cerebral lesions had adverse neurodevelopmental outcome whereas five of five survivors with normal pMRI had normal neurodevelopmental outcomes.…”

“…Improved prenatal diagnosis of brain injuries would allow prognostic refinement for the individual fetus that goes beyond informing families about the general risk of NDI known to be associated with specific complications of monochorionicity. While ultrasound (US) is the primary imaging modality used to monitor cMCGs for complications, more recently, prenatal magnetic resonance imaging (pMRI) has been utilized to evaluate the intracranial structures in fetuses affected by TTTS and/or death of a monochorionic co‐twin . Brain abnormalities have been identified with pMRI in between 11% and 100% of these cases, in a series ranging from 1 to 27 pregnant subjects, when US was normal.…”

Early detection of ischemic brain injuries by diffusion‐weighted imaging after radiofrequency ablation for fetal reduction in monochorionic pregnancies

“…16 Although the purpose of performing RFA is to reduce the potential neurological injuries and improve the survival of the normal co-twin, in some surviving fetuses, anemia, and intracranial lesions may subsequently occur as a result of hemodynamic imbalance related to the disease or its treatment which leads to cerebral ischemic lesions or fetal death. [17][18][19][20] Considering the possible unfavorable effects of RFA, early diagnosis of fetal neurologic complications is pivotal. Ultrasonography can be helpful in the assessment of cerebral hypoxic-ischemic injuries following RFA in the surviving twin.…”