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Chapter 12 - Single and Double Fetal Loss in Twin Pregnancy

Published online by Cambridge University Press:  11 October 2022

By
Mark D. Kilby ,
Leo Gurney ,
Janice L. Gibson  and
R. Katie Morris
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Data from UK confidential enquiries suggest a declining rate of twin stillbirth in monochorionic (MC) and dichorionic (DC) twin pregnancies with improved outcomes possibly reflecting the establishment of national guidelines for the management of multiple pregnancies. Despite this, twin pregnancies are at greater risk of all pregnancy complications, miscarriage and stillbirth than singleton pregnancies. Monochorionic twins, comprising approximately 20% of twin pregnancies, are at particular risk of fetal loss due to the unique pathological complications of a shared placenta: Twin to Twin Transfusion Syndrome (TTTS), early-onset severe selective growth restriction (sGR) and twin anaemia polycythaemia sequence (TAPS). Furthermore, following single intrauterine fetal demise (sIUFD) surviving monochorionic co-twins are exposed to an increased risk of intrauterine death, neonatal death and neurological disability. This chapter examines single and double fetal loss in DC and MC twin pregnancies, outlining the key facts, and covering the difficult issues and management challenges posed by twin demise.

Keywords

Twin pregnancychorionicitysingle intrauterine fetal demisemiscarriagestillbirth.
Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 123 - 134
Publisher: Cambridge University Press
Print publication year: 2022

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References

Van der Meij, KRM, Sistermans, EA, Macville, MVE et al. TRIDENT-2: national implementation of genome-wide non-invasive prenatal testing as a first-tier screening test in the Netherlands. Am J Hum Genet 2019 Dec 5;105(6):1091–1101.Google Scholar
Mackie, FL, Rigby, A, Morris, RK, Kilby, MD. Prognosis of the co-twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta-analysis. BJOG 2019 Apr;126(5):569–78.Google Scholar
MBBRACE-UK. Perinatal Mortality Surveillance Report. 2019. www.npeu.ox.ac.uk/mbrrace-uk/reportsGoogle Scholar
Kilby, MD, Gibson, JL, Ville, Y. Falling perinatal mortality in twins in the UK: organisational success or chance? BJOG 2019 Feb;126(3):341–7.Google Scholar
Agarwal, K, Alfirevic, Z. Pregnancy loss after chorionic villus sampling and genetic amniocentesis in twin pregnancies: a systematic review. Ultrasound Obstet Gynecol 2012 Aug;40(2):128–34.CrossRefGoogle ScholarPubMed
Glinianaia, SV, Rankin, J, Wright, C. Congenital anomalies in twins: a register-based study. Hum Reprod 2008 Jun;23(6):1306–11.CrossRefGoogle ScholarPubMed
Roberts, D, Neilson, JP, Kilby, MD, Gates, S. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 2014 Jan 30;(1):CD002073. https//:doi.org/10.1002/14651858.CD002073.pub3. PMID: 24482008.CrossRefGoogle ScholarPubMed
Slaghekke, F, Lopriore, E, Lewi, L et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet 2014;383(9935):214–51.Google Scholar
Müllers, SM, McAuliffe, FM, Kent, E et al. Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience. Eur J Obstet Gynecol Reprod Biol 2015;191:125–9.CrossRefGoogle ScholarPubMed
Litwinska, E, Syngelaki, A, Cimpoca, B, Frei, L, Nicolaides, KH. Outcome of twin pregnancy with two live fetuses at 11–13 weeks’ gestation. Ultrasound Obstet Gynecol 2020;55(1):32–8.CrossRefGoogle ScholarPubMed
Nobili, E, Paramasivam, G, Kumar, S. Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders. Aust NZ J Obstet Gynaecol 2013;53(2):114–18.Google Scholar
Pharoah, PO, Adi, Y. Consequences of in-utero death in a twin pregnancy. Lancet 2000 May 6;355(9215):1597–1602.CrossRefGoogle Scholar
RCOG. Management of monochorionic twin pregnancy: Green-Top Guideline No. 51. BJOG 2017 Jan;124(1):e1–e45.Google Scholar
Cheong-See, F, Schuit, E, Arroyo-Manzano, D et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ 2016;354:i4353.CrossRefGoogle ScholarPubMed
Nicolini, U, Pisoni, MP, Cela, E, Roberts, A. Fetal blood sampling immediately before and within 24 hours of death in monochorionic twin pregnancies complicated by single intrauterine death. Am J Obstet Gynecol 1998 Sep; 179(3 Pt 1):800–3.Google Scholar
Conte, G, Righini, A, Griffiths, PD et al. Brain-injured survivors of monochorionic twin pregnancies complicated by single intrauterine death: MR findings in a multicenter study. Radiology 2018 Aug;288(2):582–90.Google Scholar
Griffiths, PD, Sharrack, S, Chan, KL, Bamfo, J, Williams, F, Kilby, MD. Fetal brain injury in survivors of twin pregnancies complicated by demise of one twin as assessed by in utero MR imaging. Prenat Diagn 2015 Jun;35(6):583–91.CrossRefGoogle ScholarPubMed
Tanawattanacharoen, S, Taylor, MJ, Letsky, EA, Cox, PM, Cowan, FM, Fisk, NM. Intrauterine rescue transfusion in monochorionic multiple pregnancies with recent single intrauterine death. Prenat Diagn 2001 Apr;21(4):274–8.Google Scholar
Van Klink, J, Koopman, H, Middeldorp, J et al. Long-term neurodevelopmental outcome after selective feticide in monochorionic pregnancies. BJOG 2015;122(11):1517–24.CrossRefGoogle Scholar

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