Abstract
Objective:The objective of this study was to assess maternal and perinatal outcomes of twin pregnancies with single fetal demise in terms of chorionicity and fetal death time.Material and Methods:All deliveries between January 2008 and July 2015 were reviewed retrospectively and 85 twin pregnancies with single fetal demise were included. These cases were grouped according to chorionicity and fetal death time.Results:The incidence of single fetal demise was 4.7%. The mean delivery week was later in the dichorionic group (34.16±4.65) than in the monochorionic group (31.1±3.83). The ratios of deliveries before the 34th gestational week were 71.4% in monochorionics and 35% in dichorionics. Monochorionics had a 13 times greater risk for having delivery before the 37th gestational week and a 4 times greater risk for having delivery before the 34th gestational week compared with dichorionics. Furthermore, monochorionics had a 7 times greater risk for having abruptio placenta compared with dichorionics. The newborn intensive care unit admission ratios were 61.3% in dichorionics and 85.7% in monochorionics. Also, monochorionics had a 3.7 times greater risk for admission to newborn intensive care unit compared with dichorionics.Conclusion:We recommend follow-up of twin pregnancies with single fetal demise in terms of premature birth, regardless of chorionicity. Also, close monitoring is recommended for monochorionic twin pregnancies with single fetal demise in terms of premature birth before 34 weeks of gestation, abruptio placenta, the need for neonatal intensive care, and respiratory distress syndrome.
Highlights
In monozygotic twins compared with dizygotic twins pregnancy, the relative risks of exitus of two fetuses, single fetal demise, and neonatal exitus of a living fetus were reported as 20, 1.63, and 2.26, respectively (1)
Preeclampsia was observed in 27.4% (n=17) of the dichorionic twin pregnancy group and 28.6% (n=6) monochorionic twin pregnancies (p=0.919)
Monochorionic and dichorionic groups were compared according to preeclampsia and fetal death time and there was no statistically significant difference (p>0.05) (Table 1)
Summary
In monozygotic twins compared with dizygotic twins pregnancy, the relative risks of exitus of two fetuses, single fetal demise, and neonatal exitus of a living fetus were reported as 20, 1.63, and 2.26, respectively (1). The incidence of single fetal demise after the 20th week among all twin pregnancies ranges from 2.6% to 6.2% (2). Chorionicity is an important factor in the ratio of intrauterine loss; the risk of fetal demise is greater in monochorionic twin pregnancies compared with dichorionic twin pregnancies (3). The decision for delivery should be given by considering prematurity-related complications or morbidity and mortality that may be seen in the living fetus. If there are no other obstetric causes, delivery of dichorionic twin pregnancies with single fetus demise is not recommended before the 38th week (4).
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