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