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Neurological outcome in twins
1Department of Public Health, Muspratt Building, University of Liverpool, Liverpool, L69 3GB, UK.
Insights
Twins face higher risks of death and severe health issues compared to singletons. This includes neurological impairment, often linked to monochorionic twins and the vanishing twin phenomenon.
Area of Science:
- Perinatology
- Neonatology
- Developmental Neurology
Background:
- Twins exhibit increased mortality and morbidity risks beyond prematurity.
- Monochorionic twins face higher risks than dichorionic twins.
- Neurological impairment, such as cerebral palsy, is a primary concern, often linked to co-twin demise.
Purpose of the Study:
- To investigate the risks associated with twin pregnancies.
- To explore the pathogenesis of neurological impairment in twins.
- To examine the potential link between the vanishing twin phenomenon and congenital anomalies in singletons.
Main Methods:
- Comparative analysis of twin and singleton outcomes.
- Review of literature on twin-related morbidities.
- Pathophysiological examination of placental vascular anastomoses.
Main Results:
- Monochorionic twins show elevated risks compared to dichorionic twins.
- Ischemia due to placental vascular anastomoses is the likely cause of neurological damage.
- Congenital anomalies are more frequent in monozygous twins, often discordant.
Conclusions:
- Twin pregnancies carry significant risks, particularly neurological impairment in monochorionic gestations.
- The vanishing twin phenomenon may explain some cases of cerebral palsy and congenital anomalies in singletons.
- Further research is warranted to understand the full impact of twin gestation on long-term health outcomes.
Abstract:
Twins are at greater risk of death and severe morbidity than singletons which is in excess of that attributable to their greater prematurity. Monozygous, specifically monochorionic, twins are at greater risk than dichorionic twins. The major morbidity is neurological impairment usually presenting as cerebral palsy or severe learning disability and frequently, but not always, associated with fetal death of a co-twin. The likely pathogenesis of the neurological impairment is ischaemia attributable to haemodynamic imbalance via placental vascular anastomoses. In addition to the neurological impairment, congenital cardiac, renal, intestinal and other anomalies are more common but discordant in monozygous twins. It has been hypothesized that cerebral palsy and other neurological impairment in apparently singleton infants is attributable to early loss of a twin, the 'vanishing' twin phenomenon. It is also postulated that other congenital anomalies in singletons may be attributable to the same phenomenon.