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Low Rate of Cerebral Injury in Monochorionic Twins With Selective Intrauterine Growth Restriction

Published online by Cambridge University Press:  21 February 2012

Yao-Lung Chang*
Affiliation:
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan. j12054@cgmh.org.tw
Shuenn-Dyh Chang
Affiliation:
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
An-Shine Chao
Affiliation:
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
Reyin Lien
Affiliation:
Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
Po-Jen Cheng
Affiliation:
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
Ho-Yen Chueh
Affiliation:
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
*
*Address for correspondence: Yao-Lung Chang MD. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan, ROC, 333.

Abstract

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This study was conducted to determine the incidence of cerebral injury as detected by postnatal brain scan in monochorionic twins with selective intrauterine growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 73 monochorionic twin pregnancies divided into absence (group I, n = 46) or presence (group II, n = 27) of selective intrauterine growth restriction. Mild cerebral injury was defined as presenting one of the following abnormal cranial scan findings: intraventricular hemorrhage grade I, grade II, lenticulostiate vasculopathy and/or subependymal pseudocysts, while severe cerebral injury was defined as presenting intraventricular hemorrhage grade III, grade IV, cystic periventricular leukomalacia (PVL) grade II or higher, porencephalic cysts, and/or ventricular dilatation. The incidence of mild cerebral injury was not significantly different between these two groups (eight cases in group I and six cases in group II). Except for one case that later developed a seizure, the majority (13 out of 14) of cases with minor brain scan anomalies were only transient, without significant clinical impact. There was only one case diagnosed with a major brain scan anomaly (periventricular leukomalacia) in group II. One severe brain injury and three neonatal deaths all belonged to group II with abnormal umbilical artery Doppler in the growth restricted twin. In conclusion, the incidence of severe cerebral injury in monochorionic twin pregnancies with selective intrauterine growth restriction was low, at 3.7%.

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Copyright © Cambridge University Press 2010
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