Prenatal arterial ischemic stroke is associated with pregnancy complications in pregnancies with premature monochorionic twins

1. In this group of premature monochorionic twins, prenatal arterial ischemic stroke (PAIS) primarily affects the recipient twin and is associated with pregnancy complications. 

Evidence Rating Level: 2 (Good) 

Prenatal arterial ischemic stroke (PAIS) is a disruption of cerebral blood flow occurring from 20 weeks of gestation until 28 days after birth. PAIS is a leading cause of unilateral cerebral palsy and other neurological issues in children. Much of the previous literature has focused on full-term infants, providing limited evidence on preterm infants. This is especially true for monochorionic twins, who are also at risk due to immature cerebral circulation and unique placental factors. To assess this gap, this retrospective cohort study aimed to determine the timing of PAIS in monochorionic twins and identify risk factors, stroke patterns, and neurodevelopmental outcomes. Participants included 1183 twin pairs born at less than 35 weeks’ gestation, and PAIS was diagnosed in 1 in 18 pairs (1.5%). Pregnancy complications occurred in 89% of cases, with twin-to-twin transfusion syndrome (TTTS) presenting in 13 cases, followed by single fetal demise in 2 cases, and twin anemia polycythemia sequence (TAPS) in 1 case. The timing of strokes was quite similar, with 6 cases occurring antenatal, 7 occurring perinatal, and 5 occurring postnatal. Overall, PAIS occurring in monochorionic twins can occur during the antenatal, perinatal and postnatal period, emphasizing the importance of routine neuroimaging for early detection. 

Click to read this study in Stroke

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