Neonatal outcomes and postnatal CNS imaging
Most neonates (45/62 babies; 73%) were admitted to the neonatal/special care baby unit, the commonest reason for admission was prematurity (29/45 babies; 64%). The median length of stay in the neonatal/special care baby unit was 11.5 days (IQR: 5 - 34 days). Only 9/62 (15%) babies underwent postnatal CNS imaging: imaging in 8/9 babies was abnormal, and normal in 1 baby. It was not known if postnatal CNS imaging occurred later in 22/62 babies (35%), the remaining 31/62 (50%) did not have postnatal CNS imaging. Of the 8 babies with abnormal postnatal CNS imaging, 1 baby’s ultrasound was repeated and was subsequently was reported as “normal”; the remaining 7 were all were delivered at <36 weeks (median: 33+0 weeks, IQR: 30+3 – 34+2 weeks) with a median birthweight of 1980g (IQR:1610-2085g). Of these, 3/7 had undergone antenatal CNS imaging although the results were unknown by the reporter, the other 4 had not undergone antenatal CNS imaging. There was no association with aetiology of the initial sIUFD: 3 spontaneous at 32-34 weeks, 3 TTTS treated, 1 congenital/structural anomaly. 4/62 liveborn babies had evidence of abnormal CNS signs, all of which had abnormal postnatal CNS imaging. Only 12/60 (20%) babies discharged home were reported to have follow-up planned, 45/60 (75%) were reported to have no follow-up, these data were unknown in 3/60.
Post -mortem examination
Post-mortem examination was performed on 17/70 (24%) pregnancies for whom there were known outcomes. 4 cases were double IUFD (both twins died). The post-mortem was able to provide a cause of death in only 3/17 (18%) cases: ‘acute twin to twin transfusion’, chronic TTTS, and extreme prematurity. Post-mortem examination was inconclusive in 4 cases, the fetus was unable to be examined in 2 cases due to severe maceration, and data were missing in the 8 remaining cases. The 2 neonatal deaths did not undergo post-mortem.