Does normal fetal brain imaging in monochorionic twins following co-twin fetal demise eliminate the risk of adverse neurodevelopmental outcome?

Authors

Daphna Amitai Komem, Tally Pinchas Cohen, Shir Nov, Tal Weissbach, Irina Rabinovich, Yael Furman, Hagai Avnet, Boaz Weisz, Yoav Yinon

Published in

Archives of gynecology and obstetrics. Aug 22, 2025. Epub Aug 22, 2025.

Abstract

To assess the residual risk of long-term adverse neurodevelopmental outcomes in monochorionic twins following co-twin fetal demise and normal fetal brain imaging.
All monochorionic twin pregnancies with co-twin fetal demise were included. Patients were identified through a search of inpatient medical records for co-twin fetal demise. Cases involving fetal demise following intrauterine procedures (e.g., laser ablation or termination of pregnancy following findings on fetal brain imaging) were excluded. Following co-twin demise, fetal brain imaging, including serial neurosonogram and fetal brain MRI, was performed on the surviving fetus. Neurodevelopmental outcomes were assessed postnatally using standardized age-appropriate developmental evaluation of personal-social, language, gross and fine motor skills, as well as hearing and vision screening. Additionally, parents completed a phone-based adaptive behavior questionnaire using the Vineland-II Adaptive Behavior Scales (VABS-II).
Nineteen patients met the inclusion criteria. Two patients underwent urgent cesarean delivery due to fetal distress following co-twin demise and did not undergo any imaging. Of the 17 patients who underwent fetal brain imaging, 2 had evidence of CNS injury, one of whom later presented with mild speech delay, and the other who achieved an adequate VABS-II score. Among the fetuses with normal brain imaging and available follow-up, 45.4% (5/11) had abnormal developmental evaluations including one global delay, one motor delay, one mild hypotonia, and two moderately low scores on VABS-II.
Normal fetal CNS imaging following co-twin fetal demise in monochorionic twins does not guarantee normal neurodevelopmental outcome. This residual risk should be clearly discussed with parents during counseling to aid clinical decision- making.

PMID:
40844709
Bibliographic data and abstract were imported from PubMed on 22 Aug 2025.

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