Gold F, Saliba E, Grangeponte M C, Paillet C, Pourcelot D, Toutain A, Pierre F, Fignon A, Body G, Laugier J
Centre de Diagnostic Prénatal et de Médecine Foetale, Hôpital Bretonneau, Tours.
Arch Fr Pediatr. 1992 Jun-Jul;49(6):529-33.
The death of one twin in utero may result in visceral lesions, of possible vascular origin, in the surviving twin when the pregnancy is monochorionic and diamniotic.
Case n. 1: The death of one twin and enlargement of the ventricular system in the other were seen by ultrasonography at 24 weeks of pregnancy, 8 weeks after the mother had a fall on the stairs. The heterogeneous imaging in the inferior part of placenta suggested a clot in this area. The pregnancy was terminated at 28 weeks because the ventricular dilatation continued to increase. The newborn died a few minutes later and examination of the placenta showed that the pregnancy was monochorionic and monoamniotic. Case n. 2: The death of one twin with macerating features was seen by ultrasonography at 31 weeks. The other twin was born at 32 weeks of a dichorionic, diamniotic pregnancy. Injection of milk into the placental vasculature failed to visualize any vascular anastomoses between the two placentas, but ultrasonography showed bilateral cystic lesions in the frontal lobes of the brain. Case n. 3: Acute polyhydramnios developed at 21 weeks of pregnancy; it was treated by 3 amniocenteses, while ultrasonography of the twins was normal. A fetal transfusion syndrome was observed at birth, the pregnancy being monochorionic and diamniotic. Cranial ultrasound on day 6 was normal in the recipient twin, but showed numerous cerebral cavities in the donor, which was confirmed at autopsy after that this twin suddenly died at 2 months of age.
Brain lesions of vascular origin, can be observed in any type of twin pregnancies. They may be the result of transfusion of clot or thromboplastin-rich blood from the donor fetus through vascular anastomoses in a monochorionic placenta. They also may be due to anoxo-ischemic lesions in the absence of such anastomoses, or, in the fetal transfusion syndrome, to circulatory difficulties in one of the twins, as observed in premature singletons. In the cas of anoxo-ischemic lesions, anticipating the birth of the surviving twin is not justified.
在单绒毛膜双羊膜囊妊娠中，宫内一个胎儿死亡可能导致存活胎儿出现可能源于血管的内脏病变。
病例1：妊娠24周时超声检查发现一个胎儿死亡，另一个胎儿脑室系统扩大，此时距离母亲在楼梯上摔倒已有8周。胎盘下部的不均匀影像提示该区域有凝血块。由于脑室扩张持续增加，妊娠于28周终止。新生儿几分钟后死亡，胎盘检查显示妊娠为单绒毛膜单羊膜囊。病例2：妊娠31周时超声检查发现一个胎儿死亡并有浸软特征。另一个胎儿在双绒毛膜双羊膜囊妊娠32周时出生。向胎盘血管内注射牛奶未能显示两个胎盘之间的任何血管吻合，但超声检查显示双侧脑额叶有囊性病变。病例3：妊娠21周时出现急性羊水过多；通过3次羊膜腔穿刺进行治疗，而双胎超声检查正常。出生时观察到胎儿输血综合征，妊娠为单绒毛膜双羊膜囊。接受输血的双胎出生后第6天头颅超声正常，但供血双胎显示有许多脑腔，该双胎在2个月大时突然死亡，尸检证实了这一点。
血管源性脑损伤可见于任何类型的双胎妊娠。它们可能是由于来自供血胎儿的富含凝血块或凝血活酶的血液通过单绒毛膜胎盘的血管吻合口输血所致。在没有这种吻合口的情况下，也可能是由于缺氧缺血性损伤，或者在胎儿输血综合征中，是由于其中一个双胎出现循环困难，就像在早产单胎中观察到的那样。在缺氧缺血性损伤的情况下，预期存活双胎的出生是不合理的。
