DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212961

Maternal and neonatal outcome of twin pregnancies with single fetal demise

Gunjan Rai, Sudhir Mansingh, Bikram Bhardwaj

Abstract


 

Background: In current study we managed twin pregnancies having single fetal demise with a successful outcome. Generally monochorionic and monoamniotic pregnancies are having high probability of complications, so we have to be more watchful in these pregnancies. Termination of pregnancy is not the only option as we can manage and prolong pregnancies with a good outcome by strict monitoring of patients. Aim of our study was to look for fetomaternal outcome in twin pregnancies with single fetal demise.

Methods: This is a retrospective study done between July 2017 to June 2020 at Command hospital, Panchkula, Haryana. Total 3249 deliveries have been conducted during above said period. Out of which 47 deliveries were having twin pregnancy. We had six twin pregnancies who reported with one fetal demise. These cases were managed with regular monitoring of coagulation profile and strict fetal surveillance for surviving twin. The cases were studied for antenatal, postnatal and any neonatal complication.

Results: No antenatal, postnatal maternal or any neonatal complication observed in this study. During study period we delivered total 3249 patients, out of which 47 were twin pregnancy. Out of these 47 (1.44%) twins’ pregnancies 33 (70.31%) were DADC and 14 (29.69%) DAMC. We studied six twin pregnancies who had single fetal demise.

Conclusions: Even with single fetal demise pregnancies can be continued till term with strict monitoring for maternal and fetal complications. Termination is not the only answer in twin pregnancies with single fetal demise. Although our study was small, it indicates that in case of twin pregnancy with single fetal death and under good surveillance, the live fetus can be salvaged.

 


Keywords


Monochorionic, dichorionic, TTTS, Rh isoimmunization

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References


Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Barfield WD, et al. Assisted reproductive technology surveillance–United States, 2011. MMWR Surveill Summ. 2014;63:1-28

ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod. 2000;15:1856-64

Steenhaut P, Hubinont C. Perinatal mortality in multiple pregnancy. Available at: www.intechopen. com. Accessed on 28 July 2015.

Jauniaux ERM. Multiple gestation pregnancy after assisted reproductive technology. London: Cambridge University Press; 2012:82-92.

Nejat EJ, Buyuk E. Reproductive technologies and the risk of birth defects. N Engl J Med. 2012;367(9):875.

McNamara HC, Kane SC, Craig JM, Short RV, Umstad MP. A review of the mechanisms and evidence for typical and atypical twinning. Am J Obstet Gynecol. 2013;45:52-9.

Bora SA, Papageorghiou AT, Bottomley C, Kirk E, Bourne T. Reliability of transvaginal ultrasonography at 7-9 weeks' gestation in the determination of chorionicity and amnionicity in twin pregnancies. Ultrasound Obstet Gynecol. 2008;32(5):618-21.

Krauss FT, Redline RW, Gersell DJ, Nelson DM, Dicke JM. Multiple pregnancy. In: Placental pathology. Washington: American Registry of Pathology; 2004:249-82.

Peterson IR, Nyholm HCJ. Multiple pregnancies with single intrauterine demise: description of twenty-eight pregnancies. Acta Obstet Gynecol Scand. 1999;78: 202-6.

Baxi LV, Daftary A, Loucopoulos A. Single fetal demise in a twin gestation: Umbilical vein thrombosis. Gynecol Obstet Invest. 1998;46:266-67.

Axt R, Mink D, Hendrik J. Maternal and neonatal outcome of twin pregnancies complicated by single fetal death. J Perinat Med. 1999;27(3):221-7.

Enbom JA. Twin pregnancy with intrauterine death of one twin. Am J Obstet Gynecol. 1985;152:424-9.

Karl WM. Intrauterine death in a twin: implications for the survivor. In: Ward RH, Whittle M, editors. Multiple pregnancy. London: RCOG Press; 1995:218-30.

Fusi L, Gordon H. Twin pregnancy complicated by single intrauterine death. Problems and outcome with conservative management. Br J Obstet Gynaecol. 1990;97:511-6.

Landy HJ, Weingord AB. Management of multiple gestation complicated by an antepartum fetal demise. Obstet Gynecol Surv. 1989;44:171-6.

Weiner AE, Ried DE, Roby CC. Coagulation defects with intrauterine death from Rh isosensitization. Am J Obstet Gynecol. 1950;60:1015.

Spellacy WN. Antepartum complications in twin pregnancies. Clin Perinatol. 1988;15:80-5.

Romero R, Duffy TP, Berkowitz RL. Prolongation of a preterm pregnancy complicated by death of a single twin in utero and disseminated intravascular coagulation: effects of treatment with heparin. N Engl J Med. 1984;310:772.

Aslan H, Gul A, Cebeci A. The outcome of twin pregnancies complicated by single fetal death after 20 weeks of gestation. Twin Res. 2004;7(1):1-4.