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

Robinson, A.; Teoh, Mark; Edwards, Andrew; Fahey, Michael; Goergen, Stacy

doi:10.1002/pd.5059

Cited by 24 publications

(35 citation statements)

References 38 publications

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“…MRI is only performed when ultrasound scans show brain abnormalities. Some recent studies have shown the added value of MRI over ultrasound in the detection of cerebral injury in the context of TTTS [28,29]. However, the evidence is insufficient to confirm a predictive value of fetal MRI for long-term NDI, as this was never studied in large groups.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?

Spruijt

Lopriore

Tan

et al. 2019

JCM

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Despite many developments in its management, twin-to-twin transfusion syndrome (TTTS) remains an important risk factor for long-term neurodevelopmental impairment (NDI). Our objective was to compare the incidence of severe NDI in a recent cohort of TTTS survivors, treated with laser surgery from 2011 to 2014, with a previous cohort treated from 2008 to 2010. Neurological, cognitive, and motor development were assessed at two years of age. We determined risk factors associated with Bayley-III scores. Severe NDI occurred in 7/241 (3%) survivors in the new cohort compared to 10/169 (6%) in the previous cohort (p = 0.189). Disease-free survival (survival without severe impairment) did not significantly differ. Low birth weight and being small for gestational age (SGA) were independently associated with lower cognitive scores (both p < 0.01). Severe cerebral injury was related to decreased motor scores (B = −14.10; 95% CI −3.16, −25.04; p = 0.012). Children with severe NDI were born ≥32 weeks’ gestation in 53% of cases and had no evidence of cerebral injury on cranial ultrasound in 59% of cases. Our results suggest that improvement in outcome of TTTS has reached a plateau. Low birth weight, SGA, and cerebral injury are risk factors for poor neurodevelopmental outcome. Neither gestational age above 32 weeks nor the absence of cerebral injury preclude severe NDI.

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Section: Discussionmentioning

confidence: 99%

Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?

Spruijt

Lopriore

Tan

et al. 2019

JCM

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“…Sub-group analysis demonstrated that in MC twin pregnancies, those with anthe sIUFD <28 weeks were significantly more likely to have a co-twin IUFD than those with anthe sIUFD ≥28 weeks. The pathologies of TTTS and IUGRFGR were not associated with an increased risk of co-twin IUFD ( (18,26,29,38,46,48). Ultrasound "missed" 6/19 (31.5%) lesions detected on fMRI in 3 studies (29,38,46) and the other 3 studies demonstrated concordance between the two imaging modalities (18,26,48), although this difference was not statistically significant.…”

Section: Sub-groupmentioning

confidence: 96%

“…The pathologies of TTTS and IUGRFGR were not associated with an increased risk of co-twin IUFD ( (18,26,29,38,46,48). Ultrasound "missed" 6/19 (31.5%) lesions detected on fMRI in 3 studies (29,38,46) and the other 3 studies demonstrated concordance between the two imaging modalities (18,26,48), although this difference was not statistically significant. In abnormal postnatal brain imaging, it was not possible to perform sub-group analysis based on the imaging modalities of MRI or CT scan as 2 studies used ultrasound and MRI (43,48), 1 study used ultrasound and CT (32), and 2 studies did not state the mode of imaging (31,44).…”

Section: Sub-groupmentioning

confidence: 96%

Prognosis of the co‐twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta‐analysis

Mackie

Rigby

Morris

et al. 2018

BJOG

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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

Abstract: Prenatal magnetic resonance imaging resulted in changed prognostic counselling in 5/33 pregnancies. Evaluation of incorporation of pMRI into routine surveillance of complicated monochorionic gestations is needed. © 2017 John Wiley & Sons, Ltd.

Cited by 24 publications

References 38 publications

Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?

Long-Term Neurodevelopmental Outcome in Twin-to-Twin Transfusion Syndrome: Is there still Room for Improvement?

Prognosis of the co‐twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta‐analysis

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

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