An Unusual Case of Severe Pre-eclampsia and Pulmonary Edema Following Single Fetal Demise in an In Vitro Fertilization (IVF)-Conceived Twin Gestation: A Twisted Tale of Twins

Abstract

There has been a notable rise in instances of multiple-fetus pregnancies over the last decade, attributed to the widespread adoption of assisted reproductive technologies. Moreover, these pregnancies have been associated with the use of drugs to induce ovulation. While some cases involve the loss of one twin with minimal consequences for the surviving twin, the demise of a fetus after the first trimester, especially beyond three months into the pregnancy, can significantly impact the health of both the mother and the surviving fetus. Unfavorable outcomes linked to the loss of one twin after the first trimester include impaired physical growth of the surviving fetus, preterm delivery, neurological abnormalities, and, in certain instances, the death of the surviving twin. This report provides a detailed account of a specific case involving twin pregnancies where a single fetal death occurred at the 24th week of gestation, leading to severe pregnancy-induced hypertension and pulmonary edema. Upon reviewing peer-reviewed articles related to similar cases in online databases, no exact matches were identified for cases with a comparable presentation. The scarcity of literature on the development of pre-eclampsia following the death of a single fetus suggests a gap in obstetric research in this area. Consequently, the uniqueness of this case report arises from its distinctive circumstances and the limited existing literature on the subject within the obstetric community.

Keywords: multiple-fetus pregnancies; pre-eclampsia; pregnancy induced hypertension; single fetal death; twin pregnancy.

Figure 1. Twins delivered at 24 weeks of gestation: A) Twin Fetus; B) Fetus with IUD.

IUD: Intra-uterine death.

Figure 2. Pulmonary edema.

Figure 3. Improvement in pulmonary edema after treatment.

Figure 4. Abnormal hyperintense lesions confluent in both parieto-occipital lobes on T2-weighted MRI scan.

Figure 5. Abnormal hyperintense lesion confluent in both parieto-occipital lobes upon FLAIR scan.

FLAIR: Fluid-Attenuated Inversion Recovery.