Single Fetal Demise in Twin Pregnancy-A Great Concern but Still a Favorable Outcome

Abstract

The incidence of multiple pregnancies has increased in the last decades, mostly explained by the more frequent use of ovulation induction drugs and assisted reproduction techniques. Although single fetal death in the first trimester of twin pregnancy is not an uncommon event nor does it have serious consequences on the survival fetus, the death of one fetus in the second or third trimester of pregnancy is associated with a serious increase in morbidity and mortality for the surviving co-twin. Preterm labor, preeclampsia, intrauterine growth restriction (IUGR), neurological complications or even the death of the surviving twin have been associated with single fetal demise after mid gestation. We present a very rare case of twin pregnancy with single fetal demise at 26 weeks of gestation successfully managed to term.

Keywords: fetal loss; single fetal demise; twin pregnancy; twin pregnancy complications.

Figure 1

Ultrasound scan performed at 25 weeks and 4 days of gestation: (a) biparietal diameter of the growth restricted fetus appropriate for 18 weeks and 4 days of gestation; (b) abdominal circumference of the growth restricted fetus appropriate for 18 weeks and 0 days of gestation; (c) umbilical artery Doppler scan of the growth restricted fetus showing the absence of diastolic flow.

Figure 2

Ultrasound scan performed at 29 weeks and 1 day of gestation: (a), (b) dead fetus along with normal growing fetus with normal amniotic fluid; (c) cephalic extremities of the two fetuses with evident growth discordance.

Figure 3

Ultrasound scan performed at 31 weeks and 2 days of gestation: (a), (b), (c) dead fetus with consistent plastic changes along with normal growing fetus with normal amniotic fluid.

Figure 4

Macerated fetus: (a), (b) macerated fetus with the placenta; (c) macerated fetus with both placentae with evident different dimensions.