NEONATAL CRANIAL ULTRASONOGRAPHIC FINDINGS IN PRETERM TWINS COMPLICATED BY SEVERE FETOFETAL TRANSFUSION SYNDROME

OBJECTIVE: To investigate cranial ultrasonographic findings in survivo rs of monochorionic pregnancies complicated by fetofetal transfusion s yndrome. STUDY DESIGN: Case details of all monochorionic twin pregnanc ies complicated by fetofetal transfusion syndrome were obtained from t he Centre for Fetal Care database for. a 3-year period. Fetofetal tran sfusion syndrome was diagnosed according to ultrasonographic criteria. Eligible for entry were twin pregnancies resulting in live-born prete rm infants and complicated by fetofetal transfusion syndrome severe en ough to require amnioreduction. Cranial ultrasonographic scans perform ed within 48 hours of birth were reviewed for evidence of abnormality. RESULTS: Seventeen pregnancies were eligible for inclusion in the stu dy. Median gestational age was 25 weeks (between 17 and 29 weeks) at d iagnosis and 30 weeks (between 25 and 35 weeks) at delivery. Three inf ants died before ultrasonography could be performed. The remaining 31 twin infants received an early cranial ultrasonographic scan. One of t he 31 had a major cerebral infarct; 10 others had evidence of other, m ore minor, antenatally acquired lesions. CONCLUSIONS: Both donor and r ecipient survivors from pregnancies complicated by fetofetal transfusi on syndrome are at significant risk for antenatally acquired cerebral lesions. Long-term neurologic follow-up studies are indicated to deter mine the clinical significance of these lesions.