Title : Conservative management of single fetal death in a twin pregnancy
Abstract:
Background: Intrauterine death of a single fetus in a twin pregnancy during the second or third trimester is an uncommon complication and poses management challenge to the obstetrician. It also causes psychological stress and concern for the patient and her partner. We report a case of single fetal demise in a twin pregnancy, managed conservatively with a favourable outcome.
Case presentation: A 31 years old lady, G3P0020 with monochorionic diamniotic pregnancy was a routine booked antenatal case at our institute. At a gestational age of 27 weeks, following complaint of reduction in fetal movement of one-week duration. Ultrasound confirmed demise of first twin. The patient was counselled and biweekly follow up was done with serial ultrasonography and blood investigations. However, at 35-week gestation, she went into spontaneous labour and was subsequently delivered vaginally of a dead female leading twin (papyraceus) and a live second twin with ambiguous genitalia. They weighed 260g and 1988g respectively. Both mother and baby are still in hospital for detailed evaluation of baby in view of low birth weight and ambiguous genitalia.
Discussion: The primary concern for single fetal demise in a twin pregnancy is its effect on the surviving fetus and mother. Regular antenatal care and routine ultrasonography in pregnancy are needed to make a diagnosis. Close monitoring of the wellbeing of the surviving twin and coagulation profile of the mother are crucial to manage possible complications.
