Maternal and neonatal outcome of surviving twin after single fetal demise at 25 weeks: A rare case report

Abstract

Single fetal demise in twin pregnancy in late second or third trimester is a complex clinical situation and the management may face a dilemma. This is a rare case report of continuing pregnancy for 9 weeks in an intrauterine insemination (IUI) conceived dichorionic diamniotic twin pregnancy with intrauterine fetal demise of one twin at 25 weeks of gestation. A gravida 2 abortion 1 presented to Jaipur fertility centre (Department of Reproductive Medicine & Medical Genetics, MGUMST) with unexplained infertility of 3 years. She conceived with IUI at first attempt. The routine antenatal care scan at 25 weeks revealed 25 weeks 3 days single live fetus and second fetus 21 weeks with absent fetal heart pulsation and features of hydrops. The patient was hospitalized for conservative management. Regular follow-up was performed with daily fetal movement count, weekly coagulation profile, and ultrasound for fetal well-being. Inj. betamethasone was given for lung maturation at 32 weeks of gestation. She underwent caesarean section at 34 completed weeks for the preterm premature rupture of the membrane, the outcome being first fetus 2.2 kg female with Apgar score 7/10 and second macerated female fetus of 840 g. Postoperative period was uneventful for both mother and newborn. The baby was on regular check-up under a neonatologist. Her growth and neurological development was optimum according to her age group as seen on the long-term follow-up for 1 year.