Lanna Mariano Matteo, Consonni Dario, Faiola Stefano, Izzo Giana, Scelsa Barbara, Cetin Irene, Rustico Maria Angela
Fetal therapy Unit "U. Nicolini," Vittore Buzzi Children's Hospital, Università di Milano, Milan, Italy,
Unit of Epidemiology, Fondazione IRCCS Ca'Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Fetal Diagn Ther. 2020;47(1):66-73. doi: 10.1159/000500774. Epub 2019 Jun 20.
To evaluate incidence of cerebral injury and outcome in a large series of monochorionic (MC) twin survivors after spontaneous single fetal demise.
Retrospective analysis of all MC pregnancies with single fetal demise diagnosed at, or referred to, the Fetal Therapy Unit "U. Nicolini," V. Buzzi Children's Hospital, Milan, Italy, from 2004 to 2015. Survivors evaluation protocol included detailed ultrasound (US) of intracranial anatomy, Doppler investigation of peak systolic velocity in the middle cerebral artery (MCA-PSV), and magnetic resonance (MR). Data were collected on pregnancy characteristics, postnatal brain scan, and MR and neurological follow-up.
Seventy-eight consecutive MC pregnancies were analyzed. Median gestational age (GA) at single fetal demise was 22 weeks (range 15-36); median interval between single demise and live birth was 105 days (range 1-175), with a median GA at birth of 36 weeks (range 23-41). Prenatal MR was performed in 57 of 78 cases (73%). Cerebral injury affected 14/78 (18%) co-twins, 2 of whom were born immediately after single demise, with postnatal diagnosis of cerebral injury; of the other 12 fetuses that were studied before birth, 10 had a prenatal diagnosis of lesion both with US and MR, one only with MR, and in one case, a grade III intraventricular hemorrhage was reported only after delivery, which occurred at 25 weeks, 5 weeks after the single demise. Signs of fetal anemia (MCA-PSV value above 1.55 MoM) were related to a higher risk of prenatal cerebral injury; cases with postnatal diagnosis of lesion were delivered at lower GA.
Cerebral injury affects 18% of co-twin survivors after single fetal demise in MC twin pregnancies, and evaluation and follow-up of these cases can improve detection rate of such damage.
评估大量单绒毛膜（MC）双胎妊娠中一胎自然死亡后另一存活胎儿的脑损伤发生率及预后情况。
对2004年至2015年期间在意大利米兰布齐儿童医院“U. Nicolini”胎儿治疗中心确诊或转诊的所有单绒毛膜双胎妊娠且一胎死亡的病例进行回顾性分析。存活胎儿的评估方案包括详细的颅内解剖超声（US）检查、大脑中动脉收缩期峰值流速（MCA-PSV）的多普勒检查以及磁共振（MR）检查。收集了妊娠特征、产后脑部扫描、磁共振成像和神经学随访的数据。
分析了连续78例单绒毛膜双胎妊娠病例。单胎死亡时的中位孕周（GA）为22周（范围15 - 36周）；单胎死亡与活产之间的中位间隔时间为105天（范围1 - 175天）,出生时的中位孕周为36周（范围23 - 41周）。78例中有57例（73%）进行了产前磁共振成像检查。脑损伤影响了14/78（18%）的存活双胎，其中2例在单胎死亡后立即出生，产后诊断为脑损伤；在出生前接受检查的其他12例胎儿中，10例通过超声和磁共振成像产前诊断出病变，1例仅通过磁共振成像诊断出病变，还有1例在25周出生（单胎死亡后5周），产后才报告有III级脑室内出血。胎儿贫血迹象（MCA-PSV值高于1.55倍中位数）与产前脑损伤风险较高相关；产后诊断出病变的病例出生时孕周较低。
在单绒毛膜双胎妊娠中，一胎死亡后，18%的存活双胎会受到脑损伤，对这些病例的评估和随访可以提高此类损伤的检出率。
