[Twin pregnancy with single fetal death: etiology, management and outcome].
BACKGROUND
Intra-uterine fetal death (IUFD) of one twin is a relatively frequent complication of twin pregnancy. Prognosis of the surviving twin seems to be the main problem. Management is not consensual and suffers from the lack of guidelines.


OBJECTIVE
To report the main involved etiologies, assess the surviving co-twin outcome and discuss strategies of management.


METHODS
Retrospective study of 33 twin pregnancies complicated by single intrauterine fetal death after 26 weeks of gestation, admitted in the department "A" of obstetrics and gynecology of the Tunisian center of maternity and neonatalogy from January 2000 to October 2008.


RESULTS
Prevalence was 2.98%. Chorionicity was precised for 28 GG; 67.9% (n=19) were bichorionic (BC) and 32.1% (n=9) monochorionic (MC). The mean gestational age at the time of fetal death diagnosis was 31 weeks+2 days. Main involved pathologies in case of BC pregnancy were: intrauterine growth restriction (36.8%), pre-eclampsia (21%) and gestational diabetes (15.8%) and in case of MC pregnancy: twin-to-twin transfusion syndrome (44.4%). Prematurity rate was 85.2%. IUFD of the second twin occurred in one case and neonatal death in six cases. Tranfontanellar ultrasound on the seventh day of life found cerebral abnormalities in six liveborns.


CONCLUSIONS
Surviving co-twin prognosis was mainly compromised by prematurity and its consequences.
Chelli
D
D
Service de gynécologie et d'obstétrique << A >>, centre de maternité et de néonatologie de Tunis, rue Jabel-Lakhdar, La-Rabta, 1007 Tunis, Tunisie.
Methni
A
A
Boudaya
F
F
Marzouki
Y
Y
Zouaoui
B
B
Jabnoun
S
S
Sfar
E
E
Chennoufi
M B
MB
Chelli
H
H
D000328:Adult; D005260:Female; D005313:Fetal Death / Q000453:epidemiology* / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D014416:Tunisia / Q000453:epidemiology; D014427:Twins