Perinatal Stroke Outcomes in Twin Pregnancies

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Perinatal stroke, defined as a cerebrovascular event occurring between 20 weeks of gestation and 28 days after birth, is a leading cause of lifelong neurological disability in children. While it is relatively rare, its impact is significant—especially in twin pregnancies, which carry their own set of unique physiological and medical complexities. As the global incidence of twin births increases, understanding how perinatal stroke outcomes differ in these pregnancies becomes crucial for neonatal care and early intervention.

Understanding Perinatal Stroke in Twins:Twin pregnancies are inherently higher risk compared to singleton pregnancies. Factors such as preterm birth, intrauterine growth restriction (IUGR), and complications like twin-twin transfusion syndrome (TTTS) all contribute to increased vulnerability. These conditions can lead to reduced placental blood flow or oxygenation, which are key contributors to perinatal stroke.

Perinatal strokes in twins may also be missed or misdiagnosed early due to overlapping or subtle symptoms in one or both infants. In many cases, the diagnosis is only made after developmental delays or motor impairments are noticed later in infancy or toddlerhood.

Types and Diagnosis:The most common form of perinatal stroke is arterial ischemic stroke (AIS), typically affecting the middle cerebral artery. Cerebral sinovenous thrombosis (CSVT) and hemorrhagic strokes are also observed, though less frequently. MRI remains the gold standard for diagnosis, often supported by EEG and neurodevelopmental assessments.

Clinical Outcomes in Twin Pregnancies:Emerging studies suggest that outcomes of perinatal stroke in twins are broadly similar to those in singletons when controlled for birth weight and gestational age. However, twins often face additional hurdles such as respiratory complications and NICU stays, which can compound neurological recovery.

Motor outcomes such as hemiparetic cerebral palsy are common, and about 40-60% of affected twins may experience long-term challenges in speech, cognition, or behavior. Yet, early diagnosis, physical therapy, and family-centered neurodevelopmental care can lead to remarkable improvements, especially when started within the first six months of life.

Prevention and Early Intervention:Timely maternal-fetal monitoring, especially in monochorionic twins, is key. Managing maternal risk factors like hypertension, gestational diabetes, and thrombophilia is essential. After birth, any signs of seizures, muscle asymmetry, or feeding difficulties should be evaluated immediately with imaging.

Conclusion:While twin pregnancies inherently pose higher risks for perinatal stroke, proactive maternal care and vigilant neonatal monitoring can significantly improve outcomes. Awareness, timely diagnosis, and early therapeutic interventions remain the pillars of optimal neurodevelopment in affected twins. As research deepens, a better understanding of perinatal stroke in twin contexts will drive innovations in both prevention and recovery strategies.

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