Multicystic encephalomatacia after first-trimester intrauterine fetal death in monochorionic twins

Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 03/2004; 190(2):563-5. DOI: 10.1016/S0002-9378(03)00824-X
Source: PubMed


Multicystic encephalomalacia occurs in approximately 20% of surviving cotwins after second- and third-trimester intrauterine fetal death of one twin in monochorionic pregnancies. We report a case of multicystic encephalomalacia after the demise of a cotwin in the first trimester diagnosed by magnetic resonance imaging and confirmed pathologically.

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    • "By using of ultrasonography, we can easily detect ventriculomegaly in early gestational age. In 2 reported cases [8,10] and our case, brain injury with ventriculomegaly tend to be detected earlier only with ultrasonograpy, respectively at 19 weeks, at 18 weeks 6 days and at 20 weeks 3 days. In the other 2 cases [7,9], only microcephaly or head growth restriction was detected by ultrasonography respectively at 28 weeks and at 23 weeks 4 days. "
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    ABSTRACT: Patient: Female, 28 Final Diagnosis: Single intrauterine fetal death Symptoms: - Medication: - Clinical Procedure: - Specialty: Obstetrics and Gynecology. Rare disease. Single fetal death in monochorionic twin pregnancy may result in poor perinatal outcome of the surviving twin, including neurologic sequelae, other organ injury, and death. In most reported cases of poor perinatal outcome in the surviving twin, monochorionic co-twin death occured after more than 20 weeks of gestation, while few with earlier occurrence have been presented. A 28-year-old primigravid woman was referred to our hospital at 18 3/7 weeks of gestation for perinatal management of single fetal death in a monochorionic-diamniotic twin pregnancy. Our first evaluation by ultrasonography revealed a dead twin sized at 16 weeks of gestation, and an alive one with normal size and appearance, together with 1 placenta and 2 amniotic cavities with normal fluid amounts. At 20 3/7 weeks of gestation, ultrasonography showed that the surviving twin had bilateral ventriculomegaly and dilatation all around the subarachnoid cavity despite a normal head size. Fetal magnetic resonance imaging revealed remarkable atrophy of the cerebral cortex. After counseling, the patient and family chose termination of pregnancy, and artificial abortion was performed at 21 weeks of gestation. The aborted fetuses were not anomalous. Autopsy pathological findings confirmed encephalomalacia in the surviving twin. Recent development of imaging device make it possible that several abnormalities in central nervous system can be detected in detail at earlier gestational age. It is important to keep this condition in mind even though single fetal death occurred at early gestational age.
    American Journal of Case Reports 09/2013; 14:341-4. DOI:10.12659/AJCR.889478
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    • "Fetal death is defined as death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy (World Health Organisation, 1993). Late fetal deaths, after 24 weeks gestation in twin gestations, are associated with major morbidity such as cerebral palsy and various congenital anomalies in the surviving co-conceptus (Melnick, 1977; Hagay et al., 1986; Carlson and Towers, 1989; Cherouny et al., 1989; Fusi and Gordon, 1990; Van den Veyver et al., 1990; Ishimatsu et al., 1994; Kilby et al., 1994; Lin et al., 1999; Pharoah and Adi, 2000; Weiss et al., 2004). Whether or not early fetal death, before 24 weeks gestation, may be associated with similar risks of death or morbidity in the co-twin is less certain. "
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    ABSTRACT: Congenital anomalies are more common in twins than singletons but in the majority, aetiology is not known. Our aim was to test the hypothesis that survivors of an early loss in a multiple conception, compared with all singletons, are at increased risk of congenital anomaly. Data were abstracted from the UK population-based Northern Multiple Pregnancy Register and Northern Congenital Abnormality Survey, 1998-2004. Among 3311 twin conceptions, both conceptuses were lost at <16 weeks gestation in 67, and one conceptus in 142 conceptions. Of the 142 singleton survivors, two died in infancy, two were terminated for a congenital anomaly and 11 of 138 had a congenital anomaly (prevalence 915.5 per 10,000 births). There were 197 congenital anomalies among 5948 registered twin births (331.2 per 10,000). The relative risk (RR) of congenital anomalies in a singleton with early loss of a conceptus and twins was 2.40 [95% confidence interval (CI): 1.34-4.29]. There were 4265 infants with a congenital anomaly among the 206 914 singletons [206.1 per 10,000 births: RR twin:singleton 1.61 (95% CI 1.40-1.89)]. A highly significant increase in the risk of congenital anomaly in survivors from a multiple conception following early loss of a conceptus supports the hypothesis that many congenital anomalies are associated with monozygotic multiple conceptions.
    Human Reproduction 03/2009; 24(3):726-31. DOI:10.1093/humrep/den436 · 4.57 Impact Factor
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    • "It is hypothesized that even in early fetal loss, the VT may be associated with cerebral impairment in the surviving twin (Pharoah & Cooke, 1997). There have been case reports associating VT with focal cortical sclerosis (Brodtkorb et al., 2000), microcephaly with dysgenesis of corpus callosum and colpocephaly (Chen et al., 2002) and multicystic encephalomalacia (Weiss et al., 2004). However, there are no long-term systematic studies examining the consequences of a VT. "
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    ABSTRACT: Fetal death in a twin conception during second and third trimester is associated with increased risk of cerebral injury in the surviving twin. The aim of this study is to test the hypothesis that even early fetal losses as a 'vanishing' twin may be associated with an increased risk of cerebral impairment in the surviving twin. The study population comprised 362 pregnant women attending Liverpool Women's Hospital recruited between 1999 and 2001. Women were classified according to the first ultrasound scan into 3 groups: vanishing twin, twin and singleton. The vanishing twin group was further subdivided into 'definite' and 'probable'. Children from these pregnancies were assessed at 1 year of age for their development and neurological function using the Griffiths Mental and Developmental Scales and Optimality score. Children from 229 pregnancies (63.2%) attended the assessment. Information on children from a further 21 (5.8%) pregnancies was obtained through a review of hospital records. Cerebral impairment was found in 2 children from the vanishing twin group, 2 from the twin group and none from the singleton group. When cases with definite vanishing twin are considered there is a significant difference between the vanishing twin and singleton group (relative risk 6.1; 95% confidence interval 1.5-8.3; p = .03). An additional study with an increased sample size would enable a more robust conclusion.
    Twin Research and Human Genetics 03/2007; 10(1):202-9. DOI:10.1375/twin.10.1.202 · 2.30 Impact Factor
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