CONSERVATIVE MANAGEMENT OF PREGNANCY IN SINGLE TWIN DEMISE: A CHALLENGING SCENARIO

Abstract

Twins constitute 3.2% of all pregnancies and such incidences are increasing due to IVF pregnancies. Foetal demise in twin pregnancy is always a concern and the outcome of surviving twin depends on the gestational age when the demise happened and more so on chorionicity. Monochorionic twins (MC) fare poorly than dichorionic ones (DC). Neurological damage in MC twins can be significant and can be diagnosed by MRI. Overall outcome of DC twins is better than MC twins. Mothers can have complication of disseminated intravascular coagulation (DIC), Preeclampsia and preterm labour in both cases.

We present a case of DC twins, IVF pregnancy where foetal demise happened at 24 weeks. We continued with the conservative management with foetal and maternal monitoring. Patient went into labour at 32 weeks and surviving twin, weighing 1.5kg, was delivered by caesarean section. The baby was in neonatal intensive care unit (NICU) for 2 weeks, is doing well now. Conservative management with single twin foetal demise involves thorough counselling, explaining all complications, estimating the neurological impact in surviving twin in MC twins preferably through MRI with diffusion weighed images, monitoring foetus through regular scan, monitoring mother’s coagulation profile and finally delivering with an experienced team of neonatologist in a tertiary centre.

Keywords: Twin Demise; Neurological Impact; DIC