OC22.09: Neurodevelopmental outcome in single survivors of monochorionic pregnancies treated with fetoscopy

Abstract

The aim was to evaluate the prevalence of neurological abnormalities on targeted neurosonographic follow-up and the post-natal neurodevelopmental outcome in monochorionic pregnancies treated with fetoscopy and resulting in a single survivor. A consecutive series of 96 monochorionic pregnancies that underwent a fetoscopic procedure resulting in a single fetal death (laser coagulation with a subsequent fetal demise of one twin [n = 13] or cord occlusion [n = 83]) in our center were included. Follow up of the surviving fetus was carried out and a targeted central nervous system (CNS) assessment was performed through neurosonography and fetal MRI. Surgical and perinatal data were recorded in all cases. Ages and Stages Questionnaires (ASQ) test was performed to assess neurodevelopmental outcome on non-syndromic and chromosomally normal infants at 6 months age. An abnormal ASQ was considered if one or more areas were below 1SD, considered the cut off for the infant's age. Mean age at surgery was 19.1 + 3.2 weeks. Demise of one fetus after laser was detected within the first week in 12/13 cases. After a dedicated neurosonography follow-up, major alterations in CNS were found in 5 cases (5.2% of the cases) at an average of 4.32 (range 1–16.6) weeks after surgery. All cases requested termination of pregnancy. From the surviving infants, all with apparently normal CNS scans, neurodevelopmental assessment was performed at a mean age of 7 (6–14) months obtaining an abnormal score in 17.6% of the cases (expected in a normal population 10%). Neurologic follow up may pick up a small but relevant proportion of surviving fetuses with neurological injury after laser or cord occlusion for TTTS or selective IUGR. This strategy might significantly decrease the rate of instances of abnormal neurodevelopment in survivors.