Study of maternal and perinatal outcome among twin pregnancies with one twin demise

Abstract

Original Research ArticleStudy of maternal and perinatal outcome among twin pregnancies with one twin demise Sunanda N.*, Akhila M. V. INTRODUCTIONFetal loss of a twin during the first trimester is not an uncommon event. 1 However, fetal death occurring in the second or third trimester is rare with a reported incidence ranging from 0.5% to 6.8%. 1 Management of such cases is challenging to the obstetrician especially in cases of preterm single death, where the risk of fetal prematurity complications must be weighed against the possible intrauterine complications in the surviving fetus. The risk of mortality and morbidity in the surviving twin is considerable and depends on the cause, time of the death and also on the type of placentation. There is increased risk of IUGR, preterm labor, preeclampsia, survival with cerebral impairment and perinatal mortality. 2 The causes of fetal death vary and include twin-twin transfusion, placental insufficiency, intrauterine growth retardation related to preeclampsia, velamentous insertion of the cord, cord stricture, cord around the neck, and congenital abnormalities. 2 In general, chorionicity rather than zygosity determines the risk of mortality and the morbidity with increased prevalence in monochorionic ABSTRACT Background: To study the incidence, management and to determine maternal and perinatal outcome in cases of twin pregnancy with one twin demise in the second half of the pregnancy. Methods: This retrospective study was carried out at Cheluvamba Hospital, a tertiary care hospital attached to Mysore medical college and research institute between September 2009 and 2014. 19 twin pregnancies complicated by single intrauterine fetal demise (IUFD) after 20 weeks of gestation were identified from the hospital records. Data collected included maternal age, parity, antenatal complications, cause of IUFD, gestational age at diagnosis, time interval between diagnosis of IUFD and delivery, mode of delivery, birth details, type of placentation and neonatal complications.Results: The incidence of twin with one twin demise was 2.056%. Mean gestational age at presentation was 33.86 weeks. Most common cause of death was growth discordance in 7 cases followed by placental insufficiency in 4 cases. 57.89% of cases had monochorionic placentation. Neonatal course was most commonly complicated by prematurity. Maternal course was uneventful in majority (63.15%) of cases with two maternal deaths due to intravascular coagulopathy sequelae. Conclusions: Single fetal death occurs more often in monochorionic twins. The main problem for the surviving twin is prematurity. It is very important to identify the chorionicity by ultrasound examination in early pregnancy and implement specific surveillance of monochorial pregnancies.