BJOG. 2025 Nov 12. doi: 10.1111/1471-0528.70084. Online ahead of print.
ABSTRACT
BACKGROUND: Monochorionic (MC) twins are at risk of acute exsanguination after single fetal demise (sFD) due to their shared placental circulation, which may result in sequelae for survivors.
OBJECTIVES: To evaluate the prevalence of ante- and postnatal brain injury and long-term neurodevelopmental impairment (NDI) in co-twins after sFD. Secondary outcomes were the prevalence of termination of pregnancy (TOP), neonatal death (NND) and potential risk factors for brain injury.
SEARCH STRATEGY: PubMed, Embase, Scopus and Web of Science were searched to identify relevant studies in October 2024.
SELECTION CRITERIA: Studies reporting MC twin pregnancies with spontaneous sFD. Studies with selective feticide, twin reversed arterial perfusion sequence, twin anaemia-polycythaemia sequence, congenital anomalies, higher-order multiple pregnancies, fetoscopic laser surgery and double fetal demise were excluded.
DATA COLLECTION AND ANALYSIS: Systematic review and meta-analysis were performed following the PRISMA and MOOSE guidelines.
MAIN RESULTS: Thirteen studies involving 311 survivors after sFD were included. The prevalence of TOP, NND, brain injury and NDI was 3% (95% CI: 0%-7%), 6% (95% CI: 0%-16%), 27% (95% CI: 18%-37%), 6% (95% CI: 3%-11%), respectively. The median GA at birth in survivors with brain injury was 29 weeks (IQR 27.7-34.1) compared to 36 weeks (IQR: 32.3-37.0) in the overall group of survivors.
CONCLUSIONS: Brain injury occurs in one in four survivors and is associated with lower GA at birth, suggesting a double-hit injury due to a combination of exsanguination and (severe) prematurity. NDI occurs in one in 20 survivors, compared to two-thirds of those with brain injury.
TRIAL REGISTRATION: PROSPERO number: CRD42024608912.
PMID:41221693 | DOI:10.1111/1471-0528.70084
