Perinatal Outcomes of Single Intrauterine Fetal Death in Twin Pregnancies: A Tertiary Center Experience

Yıl 2023, , 219 - 225, 30.04.2023

Müjde Can İbanoğlu , Betül Tokgöz , Kadriye Yakut Yücel , Seval Yılmaz Ergani , Erkan Saglam , Aykut Kından , Cantekin İskender , Ali Çağlar

https://doi.org/10.54005/geneltip.1236186

Öz

ABSTRACT
Aim: Twin pregnancies are associated with increased perinatal mortality and morbidity compared with singleton pregnancies. Single intrauterine fetal death (sIUFD) is difficult to treat. This is because the twin who survives after sIUFD is at high risk for mortality, neurological damage, and other complications of preterm birth. Therefore, in this study, we aimed to determine the perinatal consequences for the surviving fetus. We also investigated the association between chorionicity, maternal characteristics, and fetal and maternal concomitant complications in these cases.
Methods: We conducted a retrospective case-control observational study that included twin births complicated by sIUFD followed up in the Department of Perinatology. Data, including demographic characteristics and prenatal invasive procedures, weeks of sIUFD, delivery time, fetal sex, interval between delivery and fetal loss, fetal distress, mode of delivery, birth weight, presence of placental pathology or umbilical cord abnormalities, neonatal Apgar scores in the first and fifth minutes, and need for neonatal intensive care unit (NICU), were obtained from obstetric records and hospital database.
Results: Fifty-three twin pregnancies with a single fetal death were included in the study. The mean age of the pregnants participating in the study was 30 (± 6) years. The mean body mass index (BMI) of the mother was 28.8 (22-43). Twenty-four (45.3%) cases were dichorionic (DC) diamniotic, 20 (37.7%) were monochorionic (MC) diamniotic, and 9 (17%) were monochorionic monoamniotic. The time between IUFD and birth of the live twin was 75 days in MCs and 105 days in DCs (p=0.150). The mean gestational age at birth of the surviving twin was 30 weeks’ gestation in MCs and 34 weeks’ gestation in DCs (p=0.030). In 23 (79.3%) MC pregnancies and 15 (62.5%) DC pregnancies, delivery occurred before 37 weeks (p=0.176). In addition, deliveries before 34 weeks occurred more frequently in 19 (65.5%) of MC pregnancies than in 8 (33.3%) of DC pregnancies (p=0.020).
Conclusion: We have shown that the birth of the live fetus in the MC group occurred at a significantly earlier time, and mortality and morbidity were observed more frequently in this fetus. However, this research explaining the etiology of sIUFD is insufficient.

Anahtar Kelimeler

Single intrauterine fetal death, twins, perinatal outcomes, monochorionic, dichorionic.

Destekleyen Kurum

none

Teşekkür

none

İkiz Gebeliklerde Tek İntrauterine Fetal Ölümün Perinatal Sonuçları: Üçüncül Merkez Deneyimi

Öz

ÖZET
Amaç: İkiz gebelikler, tekil gebeliklere kıyasla artmış perinatal mortalite ve morbidite ile ilişkilidir. Tek intrauterin fetal ölüm (sIUFD)ise yönetilmesi zor bir durumdur. Çünkü SIUFD'den sonra hayatta kalan ikiz, mortalite, nörolojik hasar ve diğer erken doğum komplikasyonları açısından yüksek risk altındadır. Bu nedenle bu çalışmada hayatta kalan fetüsün perinatal sonuçlarını belirlemeyi amaçladık. Ayrıca bu olgularda koryonisite, maternal özellikler ve fetal ve maternal eşlik eden komplikasyonlar arasındaki ilişkiyi de inceledik.
Yöntemler: Perinatoloji Anabilim Dalı'nda izlenen sIUFD ile komplike ikiz doğumları içeren retrospektif bir vaka kontrollü gözlemsel çalışma yürüttük. Demografik özellikler ve prenatal invaziv prosedürler, intrauterine exitus gerçekleşitiği haftaları, doğum süresi, fetal cinsiyet, doğum ile fetal kayıp arasındaki süre, fetal distres, doğum şekli, doğum ağırlığı, plasenta patolojisi veya göbek kordonu anormallikleri varlığı, neonatal Apgar skorları dahil olmak üzere veriler birinci ve beşinci dakikalar ve yenidoğan yoğun bakım ünitesi (YYBÜ) ihtiyacı, obstetrik kayıtlardan ve hastane veri tabanından elde edildi.
Bulgular: Çalışmaya tek fetal ölümü olan 53 ikiz gebelik dahil edildi. Çalışmaya katılan hastaların yaş ortalaması 30 (± 6) idi. Ortalama vücut kitle indeksi (VKİ) 28,8 (22-43) idi. Yirmi dört (%45,3) vaka dikoryonik (DC) diamniyotik, 20 (%37,7) vaka monokoryonik (MC) diamniyotik ve 9 (%17) vaka monokoryonik monoamniyotik idi. IUFD ile canlı ikizin doğumu arasındaki süre MC'lerde 75 gün, DC'lerde 105 gündü (p > 0.05). Sağ kalan ikizin doğumdaki ortalama gebelik yaşı, MK'lerde 30 haftalık, DC'lerde 34 haftalık gebelik haftasıydı (p=0.03). 23 (%79,3) MC gebelikte ve 15 (%62,5) DC gebelikte doğum 37 haftadan önce gerçekleşti (p=0,176). Ek olarak, 34 haftadan önceki doğumlar, MC gebeliklerin 19'unda (%65,5), DC gebeliklerin 8'inden (%33,3) daha sık meydana geldi (p=0,02).
Sonuç: MC grubunda canlı fetüsün doğumunun anlamlı olarak daha erken gerçekleştiğini ve bu fetüste mortalite ve morbiditenin daha sık görüldüğünü gösterdik. Ancak SIUFD etiyolojisini açıklayan araştırmalar yetersizdir.

Anahtar Kelimeler

Single intrauterine fetal death, twins, perinatal outcomes, monochorionic, dichorionic.

Kaynakça

• Blickstein I, Perlman S. Single fetal death in twin gestations. J Perinat Med. 2013;41(1):65-9.
• Stefanescu BI, Adam A-M, Constantin GB, Trus C. Single Fetal Demise in Twin Pregnancy—A Great Concern but Still a Favorable Outcome. Diseases. 2021;9(2):33.
• Hillman SC, Morris RK, Kilby MD. Single twin demise: consequence for survivors. Semin Fetal Neonatal Med. 2010 Dec;15(6):319-26.
• Quarello E, Ville Y. Particularités des grossesses gémellaires monochoriales [Specific aspects of monochorionic pregnancies]. Rev Prat. 2006 Dec 31;56(20):2239-47.
• Dias T, Arcangeli T, Bhide A, Napolitano R, Mahsud‐Dornan S, Thilaganathan B. First‐trimester ultrasound determination of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol. 2011 Nov;38(5):530-2.
• Dias T, Arcangeli T, Bhide A, Mahsud-Dornan S, Papageorghiou A, Thilaganathan B. Second-trimester assessment of gestational age in twins: validation of singleton biometry charts. Ultrasound Obstet Gynecol. 2011 Jan;37(1):34-7.
• Sun L, Chen Z, Liu J, Fu J. [Obstetric and neonatal outcomes of vanishing twin syndrome]. Nan Fang Yi Ke Da Xue Xue Bao. 2014 Oct;34(10):1537-40.
• Takahashi H, Baba Y, Matsubara S. Brain damage of surviving co twin following single fetal death in monochorionic diamniotic twin pregnancy at 8-9 weeks' gestation. Acta Obstet Gynecol Scand. 2014 Dec;93(12):1336
• Weiss JL, Cleary-Goldman J, Tanji K, Budorick N, D'alton ME. Multicystic encephalomalacia after first-trimester intrauterine fetal death in monochorionic twins. Am J Obstet Gynecol. 2004 Feb;190(2):563-5.
• Hack KE, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG. 2008 Jan;115(1):58-67.
• Cleary-Goldman J, D'Alton M. Management of single fetal demise in a multiple gestation. Obstet Gynecol Surv. 2004 Apr;59(4):285-98.
• Bajoria R, Kingdom J. The case for routine determination of chorionicity and zygosity in multiple pregnancy. Prenat Diagn. 1997 Dec;17(13):1207-25.
• Arınkan SA, Arısoy R, Api M. Assesment of pregnancy outcomes among twin pregnancies with single fetal demise regarding chorionicity and fetal death time. J Turk Ger Gynecol Assoc. 2019 Aug 28;20(3):147-153.
• Cunningham FG WJ. Williams Obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010.
• Khalil A, Cooper E, Townsend R, Thilaganathan B. Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis. Twin Res Hum Genet. 2016 Jun;19(3):207-16.
• Ong SS, Zamora J, Khan KS, Kilby MD. Prognosis for the co-twin following single-twin death: a systematic review. BJOG. 2006 Sep;113(9):992-8.
• Mackie FL, Rigby A, Morris RK, Kilby MD. Prognosis of the co-twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta-analysis. BJOG. 2019 Apr;126(5):569-578.
• Shek NW, Hillman SC, Kilby MD. Single-twin demise: pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2014 Feb;28(2):249-63.
• Lewi L, Van Schoubroeck D, Gratacós E, Witters I, Timmerman D, Deprest J. Monochorionic diamniotic twins: complications and management options. Curr Opin Obstet Gynecol. 2003 Apr;15(2):177-94.
• Giwnewer U, Wiznitzer A, Friedler JM, Sergienko R, Sheiner E. Intrauterine fetal death of one twin of diamnionic twins is associated with adverse perinatal outcome of the co-twin. J Matern Fetal Neonatal Med 2012; 25: 1453-5.
• Deveer R, Engin-Ustun Y, Mert I, Sarikaya E, Bozkurt S, Deveer M, et al. Twin pregnancies with single fetal death: analysis of 38 cases. Fetal Pediatr Pathol 2013; 31: 71-5.
• Yaman Tunç S, Ağaçayak E, Yaman Görük N, İçen MS, Fındık FM, Evsen MS et al. Single intrauterine demise in twin pregnancies: Analysis of 29 cases. Turk J Obstet Gynecol. 2015 Dec;12(4):226-229.
• Hillman SC, Morris RK, Kilby MD. Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet Gynecol. 2011 Oct;118(4):928-40.
• Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynaecol. 2004 Aug;18(4):557-76.
• de la Calle M, Bartha JL, Serrano H, Ramiro-Cortijo D. Obstetric Outcomes in the Surviving Fetus after Intrauterine Fetal Death in Bichorionic Twin Gestations. Children (Basel). 2021 Oct 16;8(10):927.