title: Cerebral injury in monochorionic twins with selective intrauterine growth restriction: a systematic review.
abstract: OBJECTIVE
  To estimate incidence and risk factors of severe cerebral injury in survivors from monochorionic pregnancies with selective intrauterine growth restriction (sIUGR) and/or birth weight discordance (BWD).
  
  
  METHODS
  Electronic databases were searched for studies describing perinatal and neurologic outcome in monochorionic twins with sIUGR and/or BWD. Exclusion criteria were twin-twin transfusion syndrome, twin anemia-polycythemia sequence, selective feticide or laser treatment.
  
  
  RESULTS
  Eleven articles were included in the systematic review. Analysis was hampered by different methodology and definitions of cerebral injury. The incidence of severe cerebral injury varied from 0% to 33% (average 8%, 52/661), and was higher in studies including single intrauterine demise [odds ratio (OR) 2.92; 95% confidence interval (CI) 0.89-9.56] and studies with a median gestational age at birth of ≤32 weeks (OR 1.56; 95% CI 1.06-2.27). The risk of severe cerebral injury was higher in pregnancies with abnormal umbilical artery Doppler (13.5% vs 2.5%; OR 7.69; 95% CI 2.56-25.00) and in larger twins (9% vs 5%; OR 1.93; 95% CI 0.95-3.92).
  
  
  CONCLUSIONS
  The incidence of severe cerebral injury in monochorionic twins with sIUGR and/or BWD is approximately 8% and is associated with abnormal umbilical artery Doppler, larger twins, intrauterine fetal demise and low gestational age at birth.
authors: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors: M J
authors: MJ
authors: Inklaar
authors: J M M
authors: JM
authors: van Klink
authors: T T
authors: TT
authors: Stolk
authors: E W
authors: EW
authors: van Zwet
authors: D
authors: D
authors: Oepkes
authors: E
authors: E
authors: Lopriore
mesh_terms: D001724:Birth Weight; D001930:Brain Injuries / Q000453:epidemiology*; D005260:Female; D005317:Fetal Growth Retardation; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D012307:Risk Factors; D014430:Twins, Monozygotic