Objective

Report maternal, fetal and neonatal complications associated with single intrauterine fetal death (sIUFD) in monochorionic twin pregnancies.

Design

Prospective observational study.

Setting

UK.

Population

81 monochorionic twin pregnancies with sIUFD after 14 weeks gestation, irrespective of cause.

Methods

UKOSS reporters submitted data collection forms using data from hospital records.

Main outcome measures

Aetiology of sIUFD; surviving co-twin outcomes: perinatal mortality, central nervous system (CNS) imaging, gestation and mode of delivery, neonatal outcomes; post-mortem findings; maternal outcomes.

Results

The commonest aetiology was twin-twin transfusion syndrome (38/81, 47%), “spontaneous” sIUFD (22/81, 27%) was second commonest. Death of the co-twin was common (10/70, 14%). Preterm birth (<37 weeks gestation) was the commonest adverse outcome (77%): half were spontaneous and half iatrogenic. Only 46/75 (61%) cases had antenatal CNS imaging, of which 33 cases had known results of which 7/33 (21%) had radiological findings suggestive of neurological damage. Postnatal CNS imaging revealed an additional 7 babies with CNS abnormalities, all born at <36 weeks, including all 4 babies exhibiting abnormal CNS signs. Major maternal morbidity was relatively common, with 6% requiring ITU admission, all related to infection.

Conclusions

Monochorionic twin pregnancies with single IUD are complex and require specialist care. Further research is required regarding optimal gestation at delivery of the surviving co-twin, preterm birth prevention, and classifying the cause of death in twin pregnancies. Awareness of the importance of CNS imaging, and follow-up, needs improvement.

中文翻译：

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单绒毛膜双胎子宫内单胎死亡的发生率，产妇，胎儿和新生儿后果：一项前瞻性观察性UKOSS研究。

目的

报告单绒毛膜双胎妊娠中与单胎内胎儿死亡（sIUFD）相关的母亲，胎儿和新生儿并发症。

设计

前瞻性观察研究。

设置

英国。

人口

妊娠14周后，有81例单绒毛膜双胎妊娠合并sIUFD，不论原因如何。

方法

UKOSS记者使用医院记录中的数据提交了数据收集表。

主要观察指标

sIUFD的病因；尚存的双胞胎结局：围产期死亡率，中枢神经系统（CNS）成像，妊娠和分娩方式，新生儿结局；验尸结果；产妇结局。

结果

病因最常见的是双胎输血综合征（38 / 81，47％），“自发性” sIUFD（22 / 81，27％）是第二常见的病因。共同双胞胎的死亡很常见（10 / 70，14％）。早产（妊娠<37周）是最常见的不良后果（77％）：一半是自发性的，一半是医源性的。只有46/75（61％）例具有产前CNS成像，其中33例具有已知结果，其中7/33（21％）的影像学表现提示神经系统损害。产后CNS成像显示，另有7例具有CNS异常的婴儿，均出生于<36周，包括所有4例表现出异常CNS征象的婴儿。孕产妇的主要发病率相对较高，有6％的病例需要ITU入院，所有这些都与感染有关。

结论

单胎IUD的单绒毛膜双胎妊娠非常复杂，需要专人护理。关于尚存的双胎分娩时的最佳妊娠，预防早产以及对双胎死亡的原因进行分类，还需要进一步的研究。对中枢神经系统成像和后续行动的重要性的认识需要提高。