Elsevier

Obstetrics & Gynecology

Volume 92, Issue 2, August 1998, Pages 215-219
Obstetrics & Gynecology

Original Articles
Risk for surviving twin after fetal death of co-twin in twin–twin transfusion syndrome

https://doi.org/10.1016/S0029-7844(98)00159-8Get rights and content

Abstract

Objective: To determine neonatal outcome of surviving twins in pregnancies complicated by twin–twin transfusion syndrome and fetal deaths of co-twins.

Methods: We retrospectively reviewed medical records of 11 women seen during 1990–1996 in our hospital who had pregnancies complicated by twin–twin transfusion syndrome and death of one fetus.

Results: The median interval between fetal death and delivery (six by cesarean delivery and five vaginally) was 2 weeks (range, 1 day to 7 weeks). Three of the 11 surviving twins died soon after birth (gestational ages at birth 32, 31, and 34 weeks; fetal death–delivery intervals 3, 7, and 7 weeks, respectively). Two survivors were severely handicapped (gestational ages at birth 29 and 33 weeks; fetal death–delivery interval 1 and 2 weeks, respectively). Two children showed cerebral echodensities on ultrasound after birth but developed normally, and four did not show any abnormalities on cerebral and abdominal ultrasound and developed normally. Five of 11 surviving twins, each born 1 week or more after fetal death of the co-twin, either died or experienced serious morbidity. In the two infants born within 1 day of fetal death, no problems were detected.

Conclusion: In monochorionic twin gestations complicated by twin–twin transfusion syndrome, approximately half of surviving twins will experience mortality or serious morbidity when co-twins die in utero.

Section snippets

Materials and methods

The study focused on all monochorionic twin pregnancies in our center from June 1990 to June 1996 with single fetal death and diagnosis of twin–twin transfusion syndrome. We retrieved the cases by reviewing the minutes of weekly meetings at our center for prenatal diagnosis and therapy. Only those cases in which the diagnosis could be confirmed in retrospect were included. We based the prenatal diagnosis on amniotic fluid discordance in both sacs and a combination of at least two of three

Results

From June 1990 to June 1996, in our center we recorded 11 (35%) of 31 cases of twin–twin transfusion syndrome in which there was intrauterine death of one twin (Table 2). In five other cases, the diagnosis of twin–twin transfusion syndrome, made prenatally on the basis of criteria mentioned earlier, had to be rejected because the placenta appeared to be dichorionic.

Median gestational age at time of diagnosis was 22 (range 14–27) weeks. Median gestational age at delivery was 32 (range 29–35)

Discussion

Twin–twin transfusion syndrome, a complication of monochorionic twin gestations, is associated with high perinatal mortality and morbidity. Death of one twin in twin–twin transfusion syndrome carries an increased risk of structural damage to the surviving twin and maternal DIC. Pritchard and Ratnoff2 first reported alterations in the maternal clotting mechanism with prolonged retention of dead fetuses. It did not occur in our study, although dead fetuses remained in utero for more than 5 weeks

References (18)

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