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


CONCLUSIONS
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.
Department of Obstetrics and Gynaecology,Medical University of Vienna,Vienna,Austria.
Birgit
B
Jatzko
Department of Pediatrics and Adolescent Medicine,Medical University of Vienna,Vienna,Austria.
Judith
J
Rittenschober-Böhm
Department of Obstetrics and Gynaecology,Medical University of Vienna,Vienna,Austria.
Mariella
M
Mailath-Pokorny
Department of Obstetrics and Gynaecology,Medical University of Vienna,Vienna,Austria.
Christof
C
Worda
Department of Radiology,Medical University of Vienna,Vienna,Austria.
Daniela
D
Prayer
Department of Radiology,Medical University of Vienna,Vienna,Austria.
Gregor
G
Kasprian
Department of Obstetrics and Gynaecology,Medical University of Vienna,Vienna,Austria.
Katharina
K
Worda
D054022:Cerebrum / Q000473:pathology*; D005260:Female; D005313:Fetal Death; D005333:Fetus / Q000473:pathology*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D014430:Twins, Monozygotic
cerebral lesions; fetal MRI; monochorionic twins; single fetal death