Temporary Resolution of Preeclamptic Symptoms After Intrauterine Death of One Twin

Abstract

In a 34 year old woman with dichorionic twin pregnancy preeclampsia resolved after the intrauterine death of one of the HLA-identical twins and recurred with the growth of the placenta of the surviving twin later in pregnancy. This case gives indirect evidence that the clinical course of preeclampsia is a dose-dependent phenomenon in conjunction with vital placental tissue.

Resolution of superimposed pre‐eclampsia, and improvement in umbilical artery flow in a surviving twin after intrauterine demise of its co‐twin

“…Other authors reported periods of time ranging from 1 to 3 weeks for resolution of various features of pre-eclampsia. 1,3,4,7 Umbilical artery flow abnormalities are also usually persistent or progressive, and our case is also the first instance in which flow in the umbilical artery has been shown to improve after the demise of one twin. Absent end diastolic flow in Twin A, which developed before the demise of Twin B, persisted for 1 month after the demise of Twin B and then there was a return of end diastolic flow.…”

“…In most of the reported cases, the twin that died in utero was growth-restricted. [1][2][3][4] In the case reported by van der Houwen et al, 4 the twin that died was growth-restricted due to triploidy. As pre-eclampsia in some dichorionic twin gestations may be linked to the poor growth of one fetus, some authors have described selective feticide of the abnormal twin.…”

“…Resolution of pre-eclampsia is extremely uncommon but has been reported, though rarely, in dichorionic twin pregnancies following intrauterine demise of one fetus. [1][2][3][4] We now report on a patient with chronic hypertension who developed early onset superimposed pre-eclampsia that resolved after intrauterine demise of a growth-restricted twin with a successful outcome for the healthy co-twin. The surviving twin initially had absent end diastolic flow, which also resolved 1 month after the demise.…”

Do preeclampsia symptoms resolve after intrauterine death of a fetus?

“…Usually preeclampsia progresses without any recovery until birth. Few cases of resolution of preeclampsia after spontaneous intrauterine death of one twin or selective termination of a dichorionic pregnancy have been reported ( 1 , 6 , 7 ) . Narasimhulu et al ( 8 ) reported resolution of superimposed preeclampsia in a surviving fetus after the intrauterine demise of its co-twin and suggested that placental involution after fetal demise was the key to resolution of preeclampsia (resolution period take 1 to 3 weeks).…”

“…Preeclampsia originates from the placenta, and its progressive clinical course is only treated by delivery of the placenta ( 1 ) . The incidence of disease is 3-5% and it is known as a major cause of maternal and perinatal mortality ( 2 ) .…”