Suchergebnisse

AbstractThis study was conducted to determine the incidence of cerebral injury as detected by postnatal brain scan in monochorionic twins with selective intrauterine growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 73 monochorionic twin pregnancies divided into absence (group I,n= 46) or presence (group II,n= 27) of selective intrauterine growth restriction. Mild cerebral injury was defined as presenting one of the following abnormal cranial scan findings: intraventricular hemorrhage grade I, grade II, lenticulostiate vasculopathy and/or subependymal pseudocysts, while severe cerebral injury was defined as presenting intraventricular hemorrhage grade III, grade IV, cystic periventricular leukomalacia (PVL) grade II or higher, porencephalic cysts, and/or ventricular dilatation. The incidence of mild cerebral injury was not significantly different between these two groups (eight cases in group I and six cases in group II). Except for one case that later developed a seizure, the majority (13 out of 14) of cases with minor brain scan anomalies were only transient, without significant clinical impact. There was only one case diagnosed with a major brain scan anomaly (periventricular leukomalacia) in group II. One severe brain injury and three neonatal deaths all belonged to group II with abnormal umbilical artery Doppler in the growth restricted twin. In conclusion, the incidence of severe cerebral injury in monochorionic twin pregnancies with selective intrauterine growth restriction was low, at 3.7%.

CDKN1C and KCNQ1OT1 are imprinted genes that might be potential regulators of placental development. This study investigated placental expressions of CDKN1C and KCNQ1OT1 in monozygotic twins with and without selective intrauterine growth restriction (sIUGR). Seventeen sIUGR and fifteen normal monozygotic(MZ) twin pairs were examined. Placental mRNA expressions of CDKN1C and KCNQ1OT1 were detected by real-time fluorescent quantitative PCR. CDKN1C protein expression was detected by immunohistochemical assay and Western-blotting. In the sIUGR group, smaller fetuses had a smaller share of the placenta, and CDKN1C protein expression was significantly increased while KCNQ1OT1 mRNA expression was significantly decreased. The CDKN1C/KCNQ1OT1 mRNA ratio was lower in the larger fetus than in the smaller fetus (p < .05). In the control group, CDKN1C protein expression showed no difference between larger and smaller fetuses, while KCNQ1OT1 mRNA expression was significantly lower in the larger fetus, and the CDKN1C/KCNQ1OT1 mRNA ratio was higher in the larger fetus than in the smaller fetus (p < .05). Our findings showed that pathogenesis of sIUGR may be related to the co-effect of the up-regulated protein expression of CDKN1C and down-regulated mRNA expression of KCNQ1OT1 in the placenta.