Outcome of twin pregnancies complicated by a single intrauterine death: a comparison with viable twin pregnancies.
OBJECTIVE
To examine the perinatal and maternal outcomes in twin pregnancies when a single intrauterine death occurs.


METHODS
This was a retrospective, observational study. Comparison was made to viable twin pregnancies.


RESULTS
Of a total 34,804 live deliveries, 342 were documented as twin births at a gestation of greater than 20 weeks (incidence 0.98%). Of the twin pregnancies over this period, 20 (5.85%) were complicated by a single intrauterine death. There was an increase in the incidence of congenital structural abnormalities among those twins dying in utero as compared to uneventful twin pregnancies (25 versus 0.3%; P < .001). A significant proportion of these twin pregnancies had monochorionic placentas (35 versus 9%; P < .001) and were admitted to special care units (70 versus 5.6%; P < .001) as compared to the normal twin sample. Maternal morbidity has previously been described as being increased. Although there was an increased risk of nonproteinuric and mild pregnancy-induced hypertension, no adverse maternal effects of conservative management were noted in this study.


CONCLUSIONS
The risk of a single fetal death in twin pregnancies is increased with a monochorionic placenta or a structural abnormality. Conservative management and regular surveillance seem advisable.
Kilby
M D
MD
Academic Department of Obstetrics, Keele University, North Staffordshire, United Kingdom.
Govind
A
A
O'Brien
P M
PM
D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D002823:Chorion; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D007363:Intensive Care Units, Neonatal; D008423:Maternal Age; D009017:Morbidity; D010343:Patient Admission / Q000706:statistics & numerical data; D010920:Placenta; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins