Single Fetal Death in Monochorionic Twin Pregnancy: Co-Twin Prognosis and Neonatal Outcome

The incidence of single fetal death in twin pregnancy varies from 0.5% - 6.8%, leaving the surviving fetus with increased morbi-mortality. The prognosis is worse in monochorionic pregnancies. In addressing these cases it should be noted referral to tertiary center with differentiated perinatal support, induction of fetal lung maturation and termination of pregnancy if there’s loss of fetal well-being or possibility of maternal complications and suspected neurological sequelae in the surviving fetus. The risk of iatrogenic prematurity should always be weighed with the possible consequences arising from the fetus staying in a hostile uterine environment. The authors describe a case of a 32-year-old pregnant woman with monochorionic/diamniotic twin pregnancy diagnosed with death of one of the fetuses due to fetal growth restriction and velamentous insertion of the umbilical cord at 30 weeks of gestation. The couple opted for termination of pregnancy at 33 weeks after documentation of brain changes in the surviving fetus.

Download Full-text

Faculty of 1000 evaluation for Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718089952.793484597 ◽

2013 ◽

Author(s):

Monika Gappa

Keyword(s):

At Risk ◽

Preterm Birth ◽

Fetal Lung ◽

Lung Maturation ◽

Fetal Lung Maturation

Download Full-text

Faculty Opinions recommendation of Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727428659.793572655 ◽

2020 ◽

Author(s):

Katie-Jane Wynne

Keyword(s):

At Risk ◽

Preterm Birth ◽

Fetal Lung ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Fetal Lung Maturation

Download Full-text

The cellular mechanism of glucocorticoid acceleration of fetal lung maturation. Fibroblast-pneumonocyte factor stimulates choline-phosphate cytidylyltransferase activity.

Journal of Biological Chemistry ◽

10.1016/s0021-9258(17)35914-8 ◽

1986 ◽

Vol 261 (5) ◽

pp. 2179-2184 ◽

Cited By ~ 2

Author(s):

M Post ◽

A Barsoumian ◽

B T Smith

Keyword(s):

Fetal Lung ◽

Cellular Mechanism ◽

Lung Maturation ◽

Choline Phosphate ◽

Fetal Lung Maturation

Download Full-text

Molecular regulation of lung maturation in near-term fetal sheep by maternal daily vitamin C treatment in late gestation

Pediatric Research ◽

10.1038/s41390-021-01489-4 ◽

2021 ◽

Author(s):

Erin V. McGillick ◽

Sandra Orgeig ◽

Beth J. Allison ◽

Kirsty L. Brain ◽

Youguo Niu ◽

...

Keyword(s):

Vitamin C ◽

Lung Development ◽

Fetal Lung ◽

Late Gestation ◽

Lung Maturation ◽

Maternal Vitamin ◽

Healthy Pregnancy ◽

Daily Vitamin ◽

Expression Of Genes ◽

Fetal Lung Maturation

Abstract Background In the fetus, the appropriate balance of prooxidants and antioxidants is essential to negate the detrimental effects of oxidative stress on lung maturation. Antioxidants improve respiratory function in postnatal life and adulthood. However, the outcomes and biological mechanisms of antioxidant action in the fetal lung are unknown. Methods We investigated the effect of maternal daily vitamin C treatment (200 mg/kg, intravenously) for a month in late gestation (105–138 days gestation, term ~145 days) on molecular regulation of fetal lung maturation in sheep. Expression of genes and proteins regulating lung development was quantified in fetal lung tissue. The number of surfactant-producing cells was determined by immunohistochemistry. Results Maternal vitamin C treatment increased fetal lung gene expression of the antioxidant enzyme SOD-1, hypoxia signaling genes (HIF-2α, HIF-3α, ADM, and EGLN-3), genes regulating sodium movement (SCNN1-A, SCNN1-B, ATP1-A1, and ATP1-B1), surfactant maturation (SFTP-B and ABCA3), and airway remodeling (ELN). There was no effect of maternal vitamin C treatment on the expression of protein markers evaluated or on the number of surfactant protein-producing cells in fetal lung tissue. Conclusions Maternal vitamin C treatment in the last third of pregnancy in sheep acts at the molecular level to increase the expression of genes that are important for fetal lung maturation in a healthy pregnancy. Impact Maternal daily vitamin C treatment for a month in late gestation in sheep increases the expression of gene-regulating pathways that are essential for normal fetal lung development. Following late gestation vitamin C exposure in a healthy pregnancy, an increase in lung gene but not protein expression may act as a mechanism to aid in the preparation for exposure to the air-breathing environment after birth. In the future, the availability/development of compounds with greater antioxidant properties than vitamin C or more specific targets at the site of oxidative stress in vivo may translate clinically to improve respiratory outcomes in complicated pregnancies at birth.

Download Full-text