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Intrauterine Fetal Demise in Multiple Gestation

Published online by Cambridge University Press:  01 August 2014

M.E. D'Alton ,
E.R. Newton  and
C.L. Cetrulo
M.E. D'Alton*
Affiliation:
Department of Maternal Fetal Medicine, St. Margaret's Hospital for Women, Boston
E.R. Newton
Affiliation:
Department of Maternal Fetal Medicine, St. Margaret's Hospital for Women, Boston
C.L. Cetrulo
Affiliation:
Department of Maternal Fetal Medicine, St. Margaret's Hospital for Women, Boston
*
St. Margaret's Hospital, 90 Cushing Avenue, Boston, MA 02125, USA

Abstract

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Fifteen cases were reviewed over a five-year period at a perinatal centre with intrauterine demise of one member of a multiple gestation. Nine cases were monozygotic twin pairs, two were dizygotic, and two were triples. Gestational age ranged from 27 to 39 weeks. The management protocol consisted of delivery in all cases after confirmation of the diagnosis. In 4 cases delivery was immediate because of spontaneous labor. In the other cases elective delivery was performed if the gestational age was 37 weeks or greater or there was evidence of preeclampsia or if amniocentesis revealed a mature lecithinsphingomyelin (L/S) ratio. Steroids were given if the L/S was immature or the attempt at amniocentesis was unsuccessful and delivery was performed 48 hours after initiation of steroid therapy. Cesarean section was the mode of delivery in 14 of the 15 cases. All of the cotwins and cotriplets survived. One survivor of a monozygous twin pair has multicystic encephalomalacia possibly implicating perinatal arterial occlusion or in utero disseminated intravascular coagulation (DIC). The intrauterine deaths are categorized into possibly avoidable deaths (2/15), unavoidable due to congenital anomalies (3/15), and unknown or unavoidable deaths (8/15).

Keywords

Intrauterine fetal demiseMultiple gestationPlacental anastomosesPerinatal arterial occlusionMulticystic encephalomalaciaIntrauterine disseminated intravascular coagulation
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 33 , Issue 1 , January 1984 , pp. 43 - 49
Copyright
Copyright © The International Society for Twin Studies 1984

References

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