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Cerebral injury in monochorionic twins with selective intrauterine growth restriction: a systematic review
Author(s) -
Inklaar M. J.,
Klink J. M. M.,
Stolk T. T.,
Zwet E. W.,
Oepkes D.,
Lopriore E.
Publication year - 2014
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4298
Subject(s) - monochorionic twins , medicine , intrauterine growth restriction , odds ratio , obstetrics , gestational age , incidence (geometry) , birth weight , confidence interval , umbilical artery , fetoscopy , pregnancy , fetus , prenatal diagnosis , genetics , physics , optics , biology
Objective To estimate incidence and risk factors of severe cerebral injury in survivors from monochorionic pregnancies with selective intrauterine growth restriction (sIUGR) and/or birth weight discordance (BWD). Methods Electronic databases were searched for studies describing perinatal and neurologic outcome in monochorionic twins with sIUGR and/or BWD. Exclusion criteria were twin–twin transfusion syndrome, twin anemia–polycythemia sequence, selective feticide or laser treatment. Results Eleven articles were included in the systematic review. Analysis was hampered by different methodology and definitions of cerebral injury. The incidence of severe cerebral injury varied from 0% to 33% (average 8%, 52/661), and was higher in studies including single intrauterine demise [odds ratio (OR) 2.92; 95% confidence interval (CI) 0.89‐9.56] and studies with a median gestational age at birth of ≤32 weeks (OR 1.56; 95% CI 1.06–2.27). The risk of severe cerebral injury was higher in pregnancies with abnormal umbilical artery Doppler (13.5% vs 2.5%; OR 7.69; 95% CI 2.56–25.00) and in larger twins (9% vs 5%; OR 1.93; 95% CI 0.95–3.92). Conclusions The incidence of severe cerebral injury in monochorionic twins with sIUGR and/or BWD is approximately 8% and is associated with abnormal umbilical artery Doppler, larger twins, intrauterine fetal demise and low gestational age at birth. © 2013 John Wiley & Sons, Ltd.