Intrauterine death of a single fetus in twin pregnancies

Abstract

The paper reports on nine twin pregnancies in the years 1982-1987 with the intrauterine death of a single fetus. The incidence of 0.10% is consistent with that reported in other comparable studies. Evaluation of the causes of death shows a preponderance of asphyxia. A fetofetal transfusion syndrome occurred in 4 cases. Eight of the pregnancies were terminated by caesarean section. One of the surviving children died in the neonatal period. The course of the neonatal period in the other babies was determined mainly by the state of maturity. No increased maternal morbidity was observed. On the basis of this and other experience described in the literature, some general guidelines are proposed for the management of the further pregnancy and delivery in such high-risk cases.

Twin-to-Twin Transfusion Syndrome: From Placental Anastomoses to Long-Term Neurodevelopmental Outcome

“…In the past, damage was thought to occur due to the release of thromboplastin and necrotic emboli from the demised fetus into the circulation of the surviving twin, causing disseminated intravascular coagulation, embolization and infarction [172][173][174]. However, current opinion is that damage results from acute exsanguination of the surviving twin into the low-pressure circulation of the demised cotwin, causing severe hypoxic-ischemic damage [24,26,65,171].…”

Single intrauterine death in monochorionic twin pregnancies

“…From 1985 to 1995, before the publication of the first papers describing procedures aimed at avoiding the risk to the survivor in case of impending death of one monochorionic twin fetus, ten series appeared in the English literature reporting 119 monochorionic twin pregnancies, in which intrauterine death of one fetus occurred 1,2,8,9,[16][17][18][19][20][21] . All the studies provided a detailed account of the outcomes for the co-twins.…”

“…In series including consecutive deliveries over several years, frequencies ranging from 2 to 6% have been reported for single intrauterine deaths complicating twin pregnancies 2,[6][7][8][9] , and up to 25% of monochorionic placentae have been associated with such a complication in one retrospective study 10 . Monozygotic twins account for 3-5% per thousand of all pregnancies 11 and 70% of them are monochorionic 12 .…”

Sonographic Evaluation of Twin Embolization Syndrome

“…Using computerized and conventional literature searching, we located 38 previously reported cases of monochorionic or presumed monochorionic twins with fetal demise of one twin and structural defects of the living twin (twin embolization syndrome) that included case history information, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In 38 of the 41 cases, an estimate of the timing of the fetal demise could be made based on the size or weight of the dead twin. The major defects detected in the 41 cases are summarized in Table 1 Sonograms were performed at a time when findings of TES could be expected in 15 of the 41 cases.…”