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Published on: August 25, 2014
Brain Injury and Neurodevelopmental Outcome in Survivors After Spontaneous Single Fetal Demise in Monochorionic
Mathies Rondagh1, Lotte C M Zwinkels1, Jeanine M M van Klink1
1Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
Background:
Monochorionic (MC) twins are at risk of acute exsanguination after single fetal demise (sFD) due to their shared placental circulation, which may result in sequelae for survivors.
Objectives:
To evaluate the prevalence of ante- and postnatal brain injury and long-term neurodevelopmental impairment (NDI) in co-twins after sFD. Secondary outcomes were the prevalence of termination of pregnancy (TOP), neonatal death (NND) and potential risk factors for brain injury.
Search Strategy:
PubMed, Embase, Scopus and Web of Science were searched to identify relevant studies in October 2024.
Selection Criteria:
Studies reporting MC twin pregnancies with spontaneous sFD. Studies with selective feticide, twin reversed arterial perfusion sequence, twin anaemia-polycythaemia sequence, congenital anomalies, higher-order multiple pregnancies, fetoscopic laser surgery and double fetal demise were excluded.
Data Collection And Analysis:
Systematic review and meta-analysis were performed following the PRISMA and MOOSE guidelines.
Main Results:
Thirteen studies involving 311 survivors after sFD were included. The prevalence of TOP, NND, brain injury and NDI was 3% (95% CI: 0%-7%), 6% (95% CI: 0%-16%), 27% (95% CI: 18%-37%), 6% (95% CI: 3%-11%), respectively. The median GA at birth in survivors with brain injury was 29 weeks (IQR 27.7-34.1) compared to 36 weeks (IQR: 32.3-37.0) in the overall group of survivors.
Conclusions:
Brain injury occurs in one in four survivors and is associated with lower GA at birth, suggesting a double-hit injury due to a combination of exsanguination and (severe) prematurity. NDI occurs in one in 20 survivors, compared to two-thirds of those with brain injury.
Trial Registration:
PROSPERO number: CRD42024608912.
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