Fetal brain injury in complicated monochorionic pregnancies

diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling

Alice Robinson, Mark Teoh, Andrew Edwards, Michael Fahey, Stacy Goergen

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

Abstract

Objective: This study aimed to determine the additional diagnostic information provided by prenatal (fetal) magnetic resonance imaging (pMRI) following tertiary ultrasound (US) for fetal cranial abnormalities in complicated monochorionic gestations. Methods: Women with complicated monochorionic gestations complicated by twin–twin transfusion syndrome, co-twin demise (CD), selective intrauterine growth restriction, and/or twin anaemia–polycythaemia sequence who were referred for pMRI after tertiary US were included. Additional diagnostic information by pMRI that changed prognostic counselling was the primary outcome. Results: Thirty-three women with 48 live fetuses had pMRI at a median of 25 weeks (range: 21–29). Three of ten survivors of spontaneous CD, one of eight survivors of CD after twin–twin transfusion syndrome and 1/30 co-survivors had diagnostic information added by pMRI that altered counselling; US was normal in two and in the other three underrepresented parenchymal injury (5/33 = 15%; 95% confidence interval ±0.27–0.03). Additional findings included occipital lobe infarction, hemispheric injury, dural sinus thrombosis, ischaemia-producing polymicrogyria and intraventricular haemorrhage. Another 8/33 women had additional information provided by pMRI that did not alter counselling. Conclusion: Prenatal magnetic resonance imaging resulted in changed prognostic counselling in 5/33 pregnancies. Evaluation of incorporation of pMRI into routine surveillance of complicated monochorionic gestations is needed.

Original languageEnglish
Pages (from-to)611-627
Number of pages17
JournalPrenatal Diagnosis
Volume37
Issue number6
DOIs
Publication statusPublished - 1 Jun 2017

Cite this

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title = "Fetal brain injury in complicated monochorionic pregnancies: diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling",
abstract = "Objective: This study aimed to determine the additional diagnostic information provided by prenatal (fetal) magnetic resonance imaging (pMRI) following tertiary ultrasound (US) for fetal cranial abnormalities in complicated monochorionic gestations. Methods: Women with complicated monochorionic gestations complicated by twin–twin transfusion syndrome, co-twin demise (CD), selective intrauterine growth restriction, and/or twin anaemia–polycythaemia sequence who were referred for pMRI after tertiary US were included. Additional diagnostic information by pMRI that changed prognostic counselling was the primary outcome. Results: Thirty-three women with 48 live fetuses had pMRI at a median of 25 weeks (range: 21–29). Three of ten survivors of spontaneous CD, one of eight survivors of CD after twin–twin transfusion syndrome and 1/30 co-survivors had diagnostic information added by pMRI that altered counselling; US was normal in two and in the other three underrepresented parenchymal injury (5/33 = 15{\%}; 95{\%} confidence interval ±0.27–0.03). Additional findings included occipital lobe infarction, hemispheric injury, dural sinus thrombosis, ischaemia-producing polymicrogyria and intraventricular haemorrhage. Another 8/33 women had additional information provided by pMRI that did not alter counselling. Conclusion: Prenatal magnetic resonance imaging resulted in changed prognostic counselling in 5/33 pregnancies. Evaluation of incorporation of pMRI into routine surveillance of complicated monochorionic gestations is needed.",
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Fetal brain injury in complicated monochorionic pregnancies : diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling. / Robinson, Alice; Teoh, Mark; Edwards, Andrew; Fahey, Michael; Goergen, Stacy.

In: Prenatal Diagnosis, Vol. 37, No. 6, 01.06.2017, p. 611-627.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Fetal brain injury in complicated monochorionic pregnancies

T2 - diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling

AU - Robinson, Alice

AU - Teoh, Mark

AU - Edwards, Andrew

AU - Fahey, Michael

AU - Goergen, Stacy

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N2 - Objective: This study aimed to determine the additional diagnostic information provided by prenatal (fetal) magnetic resonance imaging (pMRI) following tertiary ultrasound (US) for fetal cranial abnormalities in complicated monochorionic gestations. Methods: Women with complicated monochorionic gestations complicated by twin–twin transfusion syndrome, co-twin demise (CD), selective intrauterine growth restriction, and/or twin anaemia–polycythaemia sequence who were referred for pMRI after tertiary US were included. Additional diagnostic information by pMRI that changed prognostic counselling was the primary outcome. Results: Thirty-three women with 48 live fetuses had pMRI at a median of 25 weeks (range: 21–29). Three of ten survivors of spontaneous CD, one of eight survivors of CD after twin–twin transfusion syndrome and 1/30 co-survivors had diagnostic information added by pMRI that altered counselling; US was normal in two and in the other three underrepresented parenchymal injury (5/33 = 15%; 95% confidence interval ±0.27–0.03). Additional findings included occipital lobe infarction, hemispheric injury, dural sinus thrombosis, ischaemia-producing polymicrogyria and intraventricular haemorrhage. Another 8/33 women had additional information provided by pMRI that did not alter counselling. Conclusion: Prenatal magnetic resonance imaging resulted in changed prognostic counselling in 5/33 pregnancies. Evaluation of incorporation of pMRI into routine surveillance of complicated monochorionic gestations is needed.

AB - Objective: This study aimed to determine the additional diagnostic information provided by prenatal (fetal) magnetic resonance imaging (pMRI) following tertiary ultrasound (US) for fetal cranial abnormalities in complicated monochorionic gestations. Methods: Women with complicated monochorionic gestations complicated by twin–twin transfusion syndrome, co-twin demise (CD), selective intrauterine growth restriction, and/or twin anaemia–polycythaemia sequence who were referred for pMRI after tertiary US were included. Additional diagnostic information by pMRI that changed prognostic counselling was the primary outcome. Results: Thirty-three women with 48 live fetuses had pMRI at a median of 25 weeks (range: 21–29). Three of ten survivors of spontaneous CD, one of eight survivors of CD after twin–twin transfusion syndrome and 1/30 co-survivors had diagnostic information added by pMRI that altered counselling; US was normal in two and in the other three underrepresented parenchymal injury (5/33 = 15%; 95% confidence interval ±0.27–0.03). Additional findings included occipital lobe infarction, hemispheric injury, dural sinus thrombosis, ischaemia-producing polymicrogyria and intraventricular haemorrhage. Another 8/33 women had additional information provided by pMRI that did not alter counselling. Conclusion: Prenatal magnetic resonance imaging resulted in changed prognostic counselling in 5/33 pregnancies. Evaluation of incorporation of pMRI into routine surveillance of complicated monochorionic gestations is needed.

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