Beneath a silent attack: Unraveling lung and brain injuries in a surviving monoamniotic twin

Pregnancy with monochorionic monoamniotic twins is highly rare and frequently results in complications. Nevertheless, in monochorionic monoamniotic twin pregnancies, there are no reports of lung injury in the surviving fetus after single intrauterine fetal death. To the best of our knowledge, we present the first report of lung and brain injuries in a surviving fetus after single intrauterine fetal death in a monochorionic monoamniotic twin pregnancy. A male child was born with dyspnea. His healthy 39-year-old mother had a monochorionic monoamniotic twin pregnancy. After the cardiac arrest of one fetus at 17⁺² weeks of gestation, the surviving fetus showed slight bilateral ventricular dilatation from 19 weeks. Delivered full-term alongside the deceased fetus via cesarean section, the surviving fetus exhibited lung and brain injuries and was discharged at 10 days old. His prolonged inflammatory lung injury was considered related to single intrauterine fetal death, after ruling out other neonatal conditions. This case reminds obstetricians and pediatricians that single intrauterine fetal death could cause pulmonary inhalation and cerebral ischemic-hypoxic injury in monochorionic monoamniotic twin surviving fetuses. Antenatal evaluation and postnatal follow-up are essential in this type of high-risk pregnancy.