Abstract
Brain injury of the surviving twin from monochorionic pregnancies following intrauterine fetal demise during the second and third trimesters is a rare but severe complication. Monochorionicity and gestational age at the time of stillbirth seem to be decisive factors in terms of long-term neurologic outcome prediction for the survivor. Magnetic resonance imaging (MRI), diffusion weighted imaging (DWI) in particular, seem to bring the earliest and most accurate diagnosis. Ultrasound detection of brain damage is possible in later stages of fetal brain injury. It is essential to provide early diagnosis and multidisciplinary counsel to the parents to ensure informed decision making. For couples who choose to terminate pregnancy legislation related to late abortion might lead to further distress. Our paper aims to stress the importance of MRI DWI in the evaluation of surviving twins following single intrauterine fetal demise in monochorionic pregnancies and the delicate context of the medical professionals and parents facing this clinical situation, sometimes complicated by legal constraints.
Highlights
Single intrauterine fetal demise (SIUFD) complicates approximately 6% of twin pregnancies after 20 weeks of gestation (WG) [1]
Our paper aims to stress the importance of Magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) in the evaluation of surviving twins following single intrauterine fetal demise in monochorionic pregnancies and the delicate context of the medical professionals and parents facing this clinical situation, sometimes complicated by legal constraints
The objective of our work is to summarize the current knowledge regarding prenatal imaging of fetal brain injury in surviving co-twins following SIUFD in MC pregnancies
Summary
Single intrauterine fetal demise (SIUFD) complicates approximately 6% of twin pregnancies after 20 weeks of gestation (WG) [1]. A study performed by Aertsen in 2020 evaluated the usefulness of prenatal MRI in the detection of brain damage in MC twins complicated by TTTS following in utero surgery They reported two cases of cerebral lesions from 13 pregnancies complicated by SIUFD, one of which had been picked up by US, while the second was diagnosed only after MRI. A recent case report asserts that the early ischemic changes identified by DWI MRI can only be transient and if reperfusion occurs, a persistent injury is uncommon, recommending a repeat MRI two-three weeks after SIUFD [51] These observations were generated from the resemblance with the pathophysiology of stroke which states that neuronal damage depends mainly on the decreased cerebral blood flow and the duration of ischemia before reperfusion. The decision to terminate pregnancy should be reserved for those fetuses with unquestionably severe ischemic cerebral injury, precluding germinal matrix or basal ganglia damage which are categorized as minor lesions
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