Selective Fetal Growth Restriction Leading to Cerebral Injury in Monochorionic Twins: A Case Report

Area of Science:

• Perinatology
• Neonatology
• Neuroscience

Background:

• Monochorionic twin pregnancies are susceptible to complications from placental anastomoses, leading to uneven blood flow.
• Selective fetal growth restriction (sFGR) is a significant risk, potentially causing disparate fetal development.

Observation:

• A case of monochorionic twins with preeclampsia and late-onset sFGR in twin B is presented.
• Twin A experienced a periventricular venous infarction and hypoxic brain lesions; twin B showed signs of severe neurological compromise and cortical malformation.

Findings:

• Significant weight discordance (45%) was noted between the twins.
• Both twins exhibited distinct but severe cerebral injuries, including venous infarction, ischemic lesions, and pachygyria.
• sFGR-related in-utero blood volume shifts contributed to the observed neurological damage in both fetuses.

Implications:

• sFGR poses a substantial risk for severe cerebral injury and adverse neurodevelopmental outcomes in both twins.
• The management of sFGR necessitates careful consideration of the risks associated with prematurity versus the potential for severe fetal complications.
• This case highlights the complex challenges in managing monochorionic twin pregnancies complicated by sFGR and associated neurological sequelae.