Twin pregnancies complicated by the death of one fetus

The death of one ferns in a twin pregnancy can affect both the mother and the cotwin. Thirty women with twin pregnancies in whom the death of one ferns was diagnosed during the second half of pregnancy and a matched group of 30 women with uncomplicated twin pregnancies were investigated. The mean gestational age at delivery for the study and control groups was 32.0±5.0 (mean ± SD) weeks and 32.8±3.9, respectively. Twelve pregnancies (40%) were monochorionic. In 15 (50%) the diagnosis was made during active labor. The cesarean delivery rate was higher in the study group than in the control group (18 vs. 11, χ ² = 5.43, P<.02). The mean neonatal weight was similar in both groups (1,586 ± 725 g vs. 1,543±691 g). The subgroup of neonates (n=15) whose cotwins were diagnosed as dead during labor had higher birth weight as compared to the neonates (n = 15) in whom the diagnosis was made prior to delivery and were managed expectantly (1,829 ± 859 vs. 1,346 ± 474 g, P < .01). The week of delivery was similar in both subgroups. Neonatal mortality was 30% and 26.6%, while neonatal morbidity was 26.6% and 21.7%, respectively (NS). All the cases of neonatal mortality were in rite subgroup of twins in which the diagnosis of in utero death was made before 32 weeks' gestation. The death of one fetus from a twin pregnancy did not significantly jeopardize maternal health, and the neonatal outcome in the remaining twins was primarily a function of gestational age. An expectant approach to these pregnancies seems reasonable.