Intrauterine fetal demise in multiple gestation

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Neonatology

Background:

• Multiple gestations present unique challenges in perinatal care.
• Intrauterine demise of one fetus requires careful management to optimize outcomes for the surviving co-twin/co-triplet.
• Review of cases with intrauterine fetal demise in multiple gestations managed at a perinatal center.

Observation:

• Fifteen cases of intrauterine demise in multiple gestations were reviewed over five years.
• Management involved delivery, with timing based on gestational age, maternal condition (preeclampsia), or fetal lung maturity (lecithin-sphingomyelin ratio).
• Cesarean section was the delivery method in 14 out of 15 cases.

Findings:

• All surviving co-twins and co-triplets survived.
• One survivor of a monozygotic twin pair developed multicystic encephalomalacia, potentially due to perinatal arterial occlusion or disseminated intravascular coagulation (DIC).
• Intrauterine deaths were categorized as possibly avoidable (2/15), unavoidable due to congenital anomalies (3/15), or unknown/unavoidable (8/15).

Implications:

• Prompt delivery and appropriate management protocols appear effective in ensuring the survival of co-twins and co-triplets.
• Potential complications like multicystic encephalomalacia in survivors warrant further investigation and monitoring.
• Understanding the causes of intrauterine demise is crucial for improving perinatal outcomes in multiple gestations.