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DOI: DOI: http://dx.doi.org/10.21088/ijog.2321.1636.6518.15

Abstract

 Introduction: Intrauterine demise of one twin is a relatively frequent complication in multi fetal gestation. The incidence is higher in monochorionic twins compared to dichorionic twins. Mortality and morbidity of surviving twin is significantly increased in such cases. Aims: 1. To evaluate the effect of single fetal demise on surviving twin. 2. Perinatal and maternal outcome in such cases. 3. To review management of twin pregnancies with single intrauterine fetal demise. Materials and Methods: This  retrospective study was conducted at RL Jalappa hospital and research centre, Sri Devaraj Urs Medical College, kolar. Twin pregnancies  with single fetal demise were identified from parturition register and perinatal case records. Antenatal records, USG reports and neonatal summaries were analyzed. Data on maternal characteristics like age, parity, gestational age at diagnosis, antenatal, intrapartum and post natal complications were analyzed. Fetal parameters such as gestational age at single fetal demise, chorionicity, fetal biometry, biophysical profile, doppler study  and other USG details were noted. The time interval between single fetal demise and the delivery of the surviving twin and its perinatal outcome were analyzed. Results: We studied 145 twin pregnancies over a period of two years retrospectively. 17 cases were complicated with single fetal demise in 2nd/3rd trimester with incidence of 11.7%.  Mean gestational age of single fetal demise in twins was 33 weeks and maximam duration of prolongation of pregnancy was 10 weeks. 14 cases delivered between 32-36 weeks contributing to preterm birth rate of 85% and 3 cases delivered at term.12 out of 17 had same sex. 12 fetuses (76.47%) had live birth with good neonatal outcome and 5 out of 17 surviving were died in neonatal period. Cause of death being prematurity, severe growth discordancy with TTTS in 2 cases, severe growth discordancy in 3 cases and birth asphyxia, sepsis with pulmonary hemorrhage in one neonate. Prematurity was the common factor in all cases. We found that 5 mothers had preeclamsia,7 had anemia of moderate to severe degree and one case was Complicated with deranged coagulatation profile. Conclusion: Single fetal demise is more common in monochorionic twin gestations. Perinatal outcome of the surviving twin depends on the gestational age at delivery and chorionicity. Intensive fetal survaillence is needed for optimal management of such cases.The risk of conservative management should be weighed against the risk of preterm birth and its sequelae.  

Keywords: Single Intrauterine death; Twins; Monochorionicity; TTTS
 

Corresponding Author : Manjula H.M., Ex. Assistant Professor, Dept. of Obstetrics and Gynecology, Sri Devaraj URS Medical College, Hospital and Research Centre, Kolar, Karnataka 563101 India