Twin Pregnancy Complicated by Single Intrauterine Death. Problems and Outcome with Conservative Management

FUSl, L.; Gordon, H.

doi:10.1097/00006254-199105000-00008

Cited by 27 publications

(36 citation statements)

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“…In 1990 Fusi and Gordon1 reported that the neurological damage in fetuses surviving after the death of a monochorionic twin could not be predicted prenatally. Similar to one previous report11 our experience does suggest, however, that early sonographic diagnosis in utero is possible.…”

Section: Discussionmentioning

confidence: 99%

“…The intrauterine death of one twin in monochorionic twin pregnancies is associated with increased risk of perinatal mortality and long‐term morbidity for the surviving fetus, with perinatal loss in up to 40% of cases and intracranial lesions at birth in up to 46% of survivors1–3. The cause of damage is probably acute blood loss into the vascular system of the dying twin through placental anastomoses just before or at the time of death, leading to varying degrees of acute anemia and hypovolemia in the survivor2–4.…”

Section: Introductionmentioning

confidence: 99%

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Accurate neurosonographic prediction of brain injury in the surviving fetus after the death of a monochorionic cotwin

Simonazzi

Segata

Ghi

et al. 2006

Ultrasound Obstet Gynecol

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accurate neurosonographic prediction of brain injury in the surviving fetus after the death of a monochorionic cotwin

Simonazzi

Segata

Ghi

et al. 2006

Ultrasound Obstet Gynecol

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“…Although originally considered a result of thromboembolic processes, currently these devastating sequelae are thought to possibly reflect the acute blood loss into the dying twin (and hypoperfusion and resulting fetal anemia) associated with relative decrease in intrasvascular pressure of the surviving twin, concomitant with the cotwin's demise 53 . The incidence of severe residual morbidity or mortality in the surviving twin is high, yet difficult to ascertain precisely, and reportedly ranges between 17% and 46.2% 54–56 .…”

Section: Fetal Death Of One Twinmentioning

confidence: 99%

Is less intensive fetal surveillance of dichorionic twin gestations justified?

Sherer¹

2000

Ultrasound in Obstet & Gyne

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Twin gestations exhibit significantly increased perinatal morbidity and mortality rates in comparison with singleton gestations. The perinatal mortality in twins is 3±7 times higher than in singletons 1±6 . While accounting for only 2.5% of the population, twins account for 12.6% of the perinatal mortality 5 .A marked recent increase in the incidence of twinning (and other high-order multiple gestations) has occurred, reflecting widespread assisted reproductive technology (ART) modalities. As a result, approximately 50% of twin gestations currently result from infertility treatment 7,8 . In addition this recent increase in the incidence of twin gestations occurs in à skewed' fashion, with increased representation of older patients, possibly already at risk for increased uteroplacental perfusion-related, and other maternal age-related complications of pregnancy, for example, abnormal placentation. Various modalities of fetal surveillance of twins include: daily fetal kick counts, non-stress fetal testing, fetal biophysical profiles, Doppler velocimetry, ultrasonographic assessment of interval fetal growth, and enhanced surveillance of discordant twins and affected twins in twin±twin transfusion syndrome. Overall, these wide-ranging methods of increased surveillance of twins have not been investigated in a prospective fashion (randomized and stratified according to chorionicity). Accordingly, established guidelines as to the nature of testing and more specifically, currently recommended intervals between testing, are neither evidence-based or uniformly practiced. Nevertheless, most patients with antenatally detected twin gestations, are followed with increased fetal surveillance intensity in comparison with women with singleton fetuses. FIRST TRIMESTER DEPICTION OF CHORIONICITYDuring the mid-to late-1980s, prenatal depiction of chorionicity was performed with increasing precision using transabdominal ultrasonography mainly in the second and third trimesters. Originally, transabdominal ultrasonography was utilized to depict first-trimester chorionicity 9 . Recent widespread application of first-trimester transvaginal ultrasonography encompassing early detection of multiple gestations has enabled both precise and early depiction of chorionicity and amnionicity 10±15 . Correct early identification of chorionicity may affect an array of antenatal aspects of management of twin gestations including: management of structural anomalies, aneuploidy, discordant fetal growth and amniotic fluid volumes, early diagnosis and treatment of twin±twin transfusion syndrome, monoamniotic twin pregnancy and management of the surviving twin following death of a co-twin 16±18 .

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“…Historically, twin–twin transfusion syndrome (TTTS) was associated with the death of one or both fetuses in more than 80% of untreated pregnancies, particularly if problems developed before 28 weeks' gestation1, 2. Sudden deteriorations could occur, leading to death of the cotwin and neurological handicap in the survivor3, 4. The poor outcome of untreated TTTS led to the introduction of a number of interventions, including repeated serial amnioreduction, endoscopic laser photocoagulation of vascular anastomoses, amniotic septostomy and, in rare cases, in which the demise of the cotwin was certain, selective feticide.…”

Section: Introductionmentioning

confidence: 99%