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Intrauterine Embolism Syndrome: Multiple Infarction of Co‐Twin of Dead Counterpart in Utero
Author(s) -
Nakayama Masahiro
Publication year - 1993
Publication title -
neuropathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 61
eISSN - 1440-1789
pISSN - 0919-6544
DOI - 10.1111/j.1440-1789.1993.tb00208.x
Subject(s) - medicine , anastomosis , placenta , monochorionic twins , obstetrics , in utero , infarction , fetus , surgery , embolism , pregnancy , myocardial infarction , cardiology , biology , genetics
Twenty‐two cases of delivery of twins following the antepartum death of one twin are presented. Serious complications were noted in 12 of the live‐born twins. Nine live‐born twins were delivered more than 1 week after the antepartum death of their counterpart. Two who were delivered 2 days and 5 days, respectively, thereafter showed fatal cerebral and/or renal necrosis caused by multiple infarction. In one case the course from the death of the counterpart to delivery was unclear. In all of these cases monochorionic placenta with superficial vascular anastomosis was noted. The remaining 10 twins had good outcomes. Monochronic placenta was noted in 7 cases and placental superficial vascular anastomosis in 4. In these cases, the surviving twin was delivered within 4 days of the antepartum death of the counterpart. In 3 cases in which the dichorionic placenta lacked vascular anastomoses, the surviving twin also showed excellent prognosis even though the duration after demise of the counterpart was prolonged. The incidence of venous anastomosis of the placental vessels and the type of anastomosis apparently is very important in determining the live‐born twin survives. The autopsies revealed no definite evidence of intrauterine disseminated intravascular coagulation but intrauterine disseminated intravascular coagulation but intrauterine fetal embolism was considered to be the pathogenetic factor in multi‐organ infarction.