Single foetal death in twin pregnancies: review of the maternal and neonatal outcomes and management

Abstract

Objective: To review the maternal and neonatal outcomes, and management of single foetal death in twin pregnancies.

Data sources: Medline literature search (1950 to 1999) and hospital audit of single antepartum foetal deaths in twin pregnancy from 1993 through 1997.

Data selection: Key words for literature search: twin pregnancy/pregnancies; single fetal death/demise.

Data extraction: Data were extracted and reviewed independently by the authors.

Data synthesis: During the study period, 182 (0.76%) of 23,804 deliveries involved twin pregnancies. Seven (3.8%) of the twin pregnancies were complicated by the death of one foetus. Single foetal death in a twin pregnancy in the late second and third trimesters is associated with significant morbidity and mortality in the surviving co-twin, especially in a pregnancy involving monochorionic twins. Management should be individualised; conservative management is preferred by most obstetricians.

Conclusion: Single foetal death in twin pregnancies should be managed in a tertiary referral centre, where intensive foetal surveillance and adequate neonatal support are available. A multidisciplinary approach should be adopted.