Conservative Management of Single-twin Death at 22 Weeks’ Gestation at A Tertiary Hospital in North-central Nigeria: A Case Report and Review of Literature

Abstract

Background: Single-twin intrauterine death in the second and third trimesters poses a great concern and psychological stress to both the parents and the obstetrician. A multidisciplinary approach to conservative management is associated with improved perinatal outcome for the surviving twin. Case: We present a 30-year-old gravida 2 para 1 (1 alive). She had an emergency caesarean section during her first delivery. Having been referred from a military hospital, she presented at 22 weeks with single-twin intrauterine death. She was admitted and discharged after one week. Subsequently, she was managed conservatively and had weekly antenatal follow-up visits. She kept a daily fetal kick chart, had fortnightly ultrasound scans for fetal growth and wellbeing and weekly maternal clotting profile. At 37 weeks of gestation, she had a successful repeat caesarean delivery of a live, male neonate with a birth weight of 3.9kg and Apgar scores of 9 at one minute and 10 at five minutes. The remains of the dead co-twin (fetus papyraceus) were seen attached to the placenta. Follow-up by the neonatologist showed that his developmental milestones were normal and comparable to those of his singleton peers. Conclusion: The management of single-twin intrauterine death after the second trimester is psychologically tasking, requiring adequate counselling for the couple. The multidisciplinary approach, adopted in this study, improved perinatal outcome for the surviving co-twin after 15 weeks of conservative management. Prolonged paediatric follow-up of the survivor was imperative.