Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 3 , ISSUE 3 ( July-September, 2009 ) > List of Articles


Study of Fetal Neurodevelopment in Multiple Pregnancies

Guillermo Azumendi, Sejfulah Perva, Ingrid Marton, Madeeha Al-Noobi

Keywords : Cerebral palsy,assisted reproduction techniques,multiple pregnancies,ultrasound,fetal neurology

Citation Information : Azumendi G, Perva S, Marton I, Al-Noobi M. Study of Fetal Neurodevelopment in Multiple Pregnancies. Donald School J Ultrasound Obstet Gynecol 2009; 3 (3):51-60.

DOI: 10.5005/jp-journals-10009-1021

License: CC BY-NC 4.0

Published Online: 01-06-2010

Copyright Statement:  Copyright © 2009; The Author(s).


According to many reports multiple pregnancies compared to singelton have a 5-10 fold increased risk for CP and some of increased risk is due to the risk of preterm delivery, no mater whether, it mono or dizygotic conception. In those cases CP is most probably complication of peripartal periventricular hemorrhage or leukomalacia. Known fact about twins is that the lower is the gestational age at the time of delivery, the probability that they are monozygotic is greater. Monochorionic multiple pregnancies and feto-fetal hemodynamic transfusion instability are leading to cerebral ischemia. For all of mentionable reasons monozygotic multiple pregnancies have a greater risk of cerebral impairment.

CP in an apparently singleton pregnancy could be associated with a “vanishing” twin phenomenon. There are reports that some of the congenital anomalies in apparently singleton pregnancies may be associated with the unrecognized or unrecorded loss of a co-twin.

It has been established that ART conceptions are at a greater risk of CP because of the greater risk of preterm delivery. There have been many attempts to minimize CP prevalence by reduction of number of fetuses in a multifetal ART pregnancy but without affect, most probably because the majority of ART conceptions are dizygotic.

PDF Share
  1. Fetal behaviour in multifetal pregnancies studied by 4D sonography. Ultrasound Rev Obstet Gynecol 2004;4:52-58.
  2. Clinical value of fetal spontaneous movements in early pregnancy. J Perinat Med 1973;1:65-72.
  3. The emergence of fetal behaviour. I. Qualitative aspects. Early Hum Dev 1982;7:301-22.
  4. The Prenatal Origin of Behavior. Kansas: University of Kansas Press, 1952.
  5. The onset of inter-human contacts. Longitudinal ultrasound observations in twin pregnancies. Ultrasound Obstet Gynecol 1996;8:166-73.
  6. Clinical value of fetal spontaneous movements in early pregnancy. J Perinat Med 1973;1:65-72.
  7. Assessment of Multifetal Pregnancies. In Carrera JM, Kurjak A (Eds): Donald School Atlas of Clinical Application of Ultrasound in Obstetrics and Gynecology. Jaypee Brothers: New Delhi, 2006:133-64.
  8. Four-dimensional sonography in multiple pregnancy. Gynecol Perinatol 2003;12:157.
  9. Ultrasonographical evaluation of the incidence of simultaneous and independent movements of twin fetuses. Gynecol Obstet Invest 1987;23:5-9.
  10. Quantitative changes of general movements in preterm infants with brain lesions. Early Hum Dev 1990;23:193-97.
  11. The assessment of multifetal pregnancies by 3D/4D sonography. In Kurjak A, Azumendi G (Eds). The fetus in three-dimensions. Taylor and Francis: London, 2007;457-83.
  12. Three-Dimensional Sonography. In Blickstein I and Keith LG (Eds) Multiple Pregnancy Epidemiology, Gestation and Perinatal outcome Taylor and Francis:London 2005:309-21.
  13. al. Spoontaneous reduction of multiple pregnancy: Incidence and effect on outcome. Am J Obstet Gynecol 2002;186:77-83.
  14. Intrauterin behavior of multiples. In Kurjak A (ed) Textbook of Perinatal Medicine. Vol II. London: Parthenon Publishig 1998;1506-31.
  15. Patterns of evoked behavior in twin pregnancies during the first 22 weeks of gestation. Early Human Development.
  16. Risk of cerebral palsy in multiple pregnancies. Obstet Gynecol Clin North Am Mar 2005;32(1):55-67.
  17. Comparison of risk factors for cerebral palsy on twins and singletons. Developmental Medicine and Child Neurology 2005;47:587-91.
  18. Cerebral Palsy and Multiple Births. In Blickstein I, Keith LG (Eds) Multiple Pregnancy. Taylor and Francis: London 2005;807-16.
  19. Cerebral palsy in multifetal pregnancies. Developmental Medicine and Child Neurology 2002;44:352-55.
  20. Causes of cerebral palsy. Current Opinion in Pediatrics 1999;11(6):487-91.
  21. Consequences of in-utero death in a twin pregnancy. Lancet 2000;355:1597-602.
  22. The risk of mortality or cerebral palsy in twins: a collaborative population-based study. Pediatr Res Nov 2002;52(5):671-81.
  23. The Vanishing Fetus. In Blickstein I and Keith LG ed. Multiple Pregnancy Epidemiology, Gestation and Perinatal outcome London. Taylor and Francis 2005:108-12.
  24. Outcome of twin gestation following sonographic demonstration of two heart beats in the first trimester. Ultrasound Obstet Gynecol 1993;3:343-45.
  25. A hypothesis for the aethiology of spastic cerebral palsy-the vanishing twin. Dev Med Child Neurol 1997;39:292-96.
  26. A Case-control Study of Vanishing Twin as a Risk Factor for Cerebral Palsy. Twin Research 2003;6(2):83-84.
  27. Cerebral palsy in triplet pregnancies with and without iatrogenic reduction. Eur J Pediatr 2004;163:449-51.
  28. Cerebral palsy in children born after IVF in Sweden 1982-1995:Type of CP and maternal/obstetrical characteristics are similar to those in non-IVF children with CP. Acta Obstet Gynecol Scand 2005;84:1215-16.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.