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Intrauterine Death in Multiple Gestation

Published online by Cambridge University Press:  01 August 2014

S. Liu ,
K. Benirschke ,
A.L. Scioscia  and
F.L. Mannino
S. Liu
Affiliation:
Departments of Pathology
K. Benirschke*
Affiliation:
Departments of Pathology
A.L. Scioscia
Affiliation:
Departments of Reproductive Medicine and Medicine
F.L. Mannino
Affiliation:
Departments of Pediatrics, University of California, San Diego, California, USA
*
Department of Pathology, University Medical Center 8321, 225 Dickinson Street, San Diego, CA 92103-8321, USA

Abstract

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Intrauterine death of one fetus in a multiple gestation is associated with significant morbidity and mortality in the surviving infant. This study is a retrospective review of 38 twin and 3 triplet gestations involving the intrauterine death of at least one fetus. The obstetrical history, placental pathology, autopsy findings, and neonatal history of the surviving infant are reviewed. Three cases involved the recent stillbirth of both twins, the remaining cases involved a surviving infant. In one case, neonatal death of a surviving twin occurred on day 19. In two sets of triplets, two stillbirths occurred, in the third case two infants were liveborn. The incidence of preterm delivery was 34%, which decreased to 18% if fetal cotwin death had occurred before 20 weeks gestation. Cesarean section was the method of delivery in 16 cases. There was an excess of velamentous cord insertions, which was most pronounced in the stillborn twin. Monochorionic placentation was found in 72%, also an excess.

Neurological damage was known to have occurred in 19 of the 39 surviving infants. Fifteen of these 19 (79%) were associated with monochorionic placentation. The neurologically damaged twin infants, when compared to the normal infants, had the cotwin die later in gestation (31 vs 16.5 weeks), had a shorter duration between the death of the cotwin and delivery (2.5 vs 21 weeks), and delivered earlier in gestation (36.5 vs 39.5 weeks). The probable cause of neurological damage, in our opinion, was either exsanguination into the dead twin fetus, or disseminated intravascular coagulation which occurred in at least 13 cases. The incidence of antepartum death in a multiple gestation, and the potential for neurological damage is probably higher than previously thought. A review of the literature is presented and the clinical implications of this phenomenon are discussed.

Keywords

TwinsFetal DeathCNS damage
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 41 , Issue 1 , January 1992 , pp. 5 - 26
Copyright
Copyright © The International Society for Twin Studies 1992

References

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