Fetal and postnatal brain MRI in premature infants with twin–twin transfusion syndrome

Merhar, Stephanie L.; Kline‐Fath, Beth M.; Meinzen‐Derr, Jareen; Schibler, Kurt; Leach, James

doi:10.1038/jp.2012.87

Cited by 23 publications

(31 citation statements)

References 41 publications

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“…Fetal germinal matrix and intraventricular hemorrhage is rare; nevertheless, when associated with parenchymal damage it might cause neurodevelopmental deficits. A recent study analyzing MRI scans in TTTS patients found similar hemorrhagic findings in 3/20 fetuses treated by FLC; in that study, in contrast to ours, MRI was performed before FLC (pers. comm.).…”

Section: Discussioncontrasting

confidence: 49%

Early detection by diffusion-weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin-twin transfusion syndrome

Weisz

Hoffmann

Ben-Baruch

et al. 2014

Ultrasound Obstet Gynecol

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Section: Discussioncontrasting

confidence: 49%

Early detection by diffusion-weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin-twin transfusion syndrome

Weisz

Hoffmann

Ben-Baruch

et al. 2014

Ultrasound Obstet Gynecol

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“…Fetal and neonatal MRI studies have shed more light on brain abnormalities detected in TTTS in the last decade. Several studies have reported additional findings of MRI compared to ultrasonography alone, including polymicrogyria and other migrational disorders, sinovenous thrombosis, and more subtle and/or diffuse white matter injury [42,64,[68][69][70][71]. Donors and recipients are equally affected by cerebral injury, although the occurrence of cerebral arterial stroke seems to be a specific risk for recipients [42,62,72].…”

Section: Cerebral Injurymentioning

confidence: 99%

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Spruijt

Lopriore

Steggerda

et al. 2020

Expert Review of Hematology

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Introduction: Twin-twin transfusion syndrome (TTTS) is a devastating complication of monochorionic twin pregnancy and remains a major challenge for worldwide fetal medicine specialists. In TTTS, intertwin transfusion through vascular anastomoses in the shared placenta leads to severe hemodynamic imbalance. This review summarizes the current knowledge of TTTS. Areas covered: The most recent insights concerning the management of TTTS, as well as fetal and neonatal complications are described. Relevant articles were selected based on a Pubmed search using the keywords below. Understanding of the underlying pathophysiology has improved greatly as a result of placental injection studies. Advancements in antenatal management have led to increased perinatal survival and a decreased incidence of neonatal complications, including brain injury and neurodevelopmental impairment. Expert opinion: Further opportunities for improvement comprise technological innovations in laser procedures and the prevention of preterm rupture of membranes with subsequent prematurity. A noninvasive treatment such as high-intensity focused ultrasound (HIFU) seems to hold promise for the future treatment of TTTS. Fetal MRI studies are important to improve our understanding of fetal brain injury and should relate their findings to long-term neurodevelopment. International collaboration and centralization of care are of paramount importance to ensure the best care for our patients.

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“…Van Klink et al (2015) reported a decreased risk of brain injury with increasing gestation of delivery (OR 0.83 for each week [95% CI 0.69-0.99] p = .05; van Klink et al, 2015). There is little other research regarding the effect of gestation of delivery in the case of sIUFD, but two studies (Merhar et al, 2013;Spruijt et al, 2012) examining the effect of gestation of delivery on brain injury in TTTS reported contradictory findings, although it is important to note that in Merhar et al (2013) there was only one case of sIUFD, and in Spruijt et al (2012) there was no mention of sIUFD. Merhar et al compared antenatal fetal brain MRIs with postnatal brain MRIs in twins with TTTS born prematurely and found a higher rate of brain injury postnatally of 68% (15/22) versus antenatally of 23% (5/22).…”

Section: Gestation Of Deliverymentioning

confidence: 99%

“…Cranial ultrasound and MRI scans should be performed if there is a suspicion of brain injury, which may confirm the findings of antenatal imaging or indicate new lesions. Postnatal ultrasound has a low sensitivity and specificity for detecting non-hemorrhagic brain injuries in neonates, although it is quick and readily available (Merhar et al, 2013). Postnatal MRI results are better correlated with long-term neurodevelopmental outcomes than postnatal ultrasound (Merhar et al, 2013).…”

Section: Postnatal Investigationsmentioning

confidence: 99%

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 and postnatal brain MRI in premature infants with twin–twin transfusion syndrome

Cited by 23 publications

References 41 publications

Early detection by diffusion-weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin-twin transfusion syndrome

Early detection by diffusion-weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin-twin transfusion syndrome

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

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

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