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首页> 外文期刊>European Journal of Obstetrics, Gynecology and Reproductive Biology: An International Journal >Perinatal outcome and neurological follow up of the cotwins in twin pregnancies complicated by single intrauterine death.
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Perinatal outcome and neurological follow up of the cotwins in twin pregnancies complicated by single intrauterine death.

机译：双胎妊娠并发单次宫内死亡的双胎妊娠的围产期结局和神经系统随访。

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OBJECTIVE: To review the outcome of twin pregnancies complicated by single fetal intrauterine death (IUD) managed at our Centre and to evaluate the neurological follow up of the surviving cotwins. STUDY DESIGN: Twenty-three twin pregnancies (10 dichorionic and 13 monochorionic diamniotic) complicated by IUD in the II or III trimester were seen at our Centre during the study period (2001-2006). All patients were managed conservatively unless non-reassuring signs of fetal well-being were present at ultrasound examination or CTG after 28 weeks, suggesting immediate delivery. Serial scans after the diagnosis of single death were performed and, in addition, eight monochorionic twin pregnancies underwent prenatal MRI in order to identify the presence of cerebral lesions in the survivors. Live born surviving cotwins underwent neurological follow up. RESULTS: In the monochorionic group one cotwin died in utero and one in the neonatal period with a perinatal survival rate of 83.4% (10/12) (excluding one case who opted for termination of pregnancy); in the dichorionic group perinatal survival rate was 100%. In all monochorionic cases there were no signs of ischemic brain lesions in the surviving cotwins at the diagnosis of single death and during ultrasonographic follow up. In monochorionic pregnancies prenatal MRI, when performed, was negative for signs of brain damage in the surviving cotwins. Gestational age at delivery was not statistically different between monochorionic and dichorionic pregnancies (36 (range, 28.4-40.2) vs. 34.6 (range, 28.2-41.3) weeks) (p=0.6) and the rate of early preterm delivery before 32 weeks was 23.8% (5/21) and independent from chorionicity (18.2% vs. 30%, p=0.5). Neurodevelopmental follow up was available for 18/20 live born survivors (85%) and was normal in all but one twin; this case was born from a dichorionic pregnancy with a suspicion of congenital infection. CONCLUSIONS: Our data confirmed a trend to a higher risk of perinatal mortality of cotwins in monochorionic twin pregnancies compared to dichorionic ones. In our experience prenatal ultrasound and MRI were useful to exclude cerebral lesions in utero and subsequent neurological sequelae in surviving monochorionic cotwins, even if definitive conclusions, especially on MRI, are limited by the small number of cases in our study.
机译：目的：回顾在我们中心管理的双胎妊娠并发单胎子宫内死（IUD）的结局，并评估幸存的双胎的神经学随访。研究设计：在研究期间（2001-2006年）在我中心接受了23例双胎妊娠（10支二甲胎和13支单绒毛膜羊膜炎）并伴有宫内节育器的妊娠。除非在28周后进行超声检查或CTG时出现令人不安的胎儿健康迹象，否则所有患者均应保守治疗，这表明应立即分娩。诊断为单例死亡后进行连续扫描，此外，对八个单绒毛膜双胎妊娠进行了产前MRI检查，以鉴定幸存者中是否存在脑部病变。活产幸存的双胞胎接受了神经学随访。结果：在单绒毛膜试验组中，一名cotwin在子宫内死亡，一名在新生儿期死亡，围生期生存率为83.4％（10/12）（不包括一例选择终止妊娠的病例）;在二绒毛膜组围产期生存率为100％。在所有单绒毛膜炎病例中，在诊断为单例死亡和超声检查期间，尚存的cotwins均无缺血性脑损伤的迹象。在单绒毛膜妊娠中，当进行产前MRI检查时，幸存的双胞胎脑损伤迹象阴性。单绒毛膜和绒毛膜绒毛妊娠的分娩妊娠年龄无统计学差异（36（28.4-40.2）周与34.6（28.2-41.3）周）（p = 0.6），并且32周前早产的发生率为23.8％（5/21），独立于绒毛膜性（18.2％vs. 30％，p = 0.5）。 18/20活着的幸存者（85％）可以进行神​​经发育随访，除一对双胞胎外，其余所有患儿均正常。该病例是由绒毛膜状双胎妊娠所生，怀疑是先天性感染。结论：我们的数据证实了单绒毛膜双胎妊娠的双胎妊娠与双绒毛胎相比，围产期死亡风险更高。根据我们的经验，即使幸存的单绒毛膜囊性囊炎的明确结论（尤其是在MRI上的结论）受到本研究中少数病例的限制，产前超声检查和MRI也可用于排除子宫内的脑部病变和随后的神经后遗症。

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