Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-27T11:29:54.012Z Has data issue: false hasContentIssue false
  • English
  • Français

Intrauterine Death in Multiple Gestation

Published online by Cambridge University Press:  01 August 2014

S. Liu ,
K. Benirschke ,
A.L. Scioscia  and
F.L. Mannino
S. Liu
Affiliation:
Departments of Pathology
K. Benirschke*
Affiliation:
Departments of Pathology
A.L. Scioscia
Affiliation:
Departments of Reproductive Medicine and Medicine
F.L. Mannino
Affiliation:
Departments of Pediatrics, University of California, San Diego, California, USA
*
Department of Pathology, University Medical Center 8321, 225 Dickinson Street, San Diego, CA 92103-8321, USA

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Intrauterine death of one fetus in a multiple gestation is associated with significant morbidity and mortality in the surviving infant. This study is a retrospective review of 38 twin and 3 triplet gestations involving the intrauterine death of at least one fetus. The obstetrical history, placental pathology, autopsy findings, and neonatal history of the surviving infant are reviewed. Three cases involved the recent stillbirth of both twins, the remaining cases involved a surviving infant. In one case, neonatal death of a surviving twin occurred on day 19. In two sets of triplets, two stillbirths occurred, in the third case two infants were liveborn. The incidence of preterm delivery was 34%, which decreased to 18% if fetal cotwin death had occurred before 20 weeks gestation. Cesarean section was the method of delivery in 16 cases. There was an excess of velamentous cord insertions, which was most pronounced in the stillborn twin. Monochorionic placentation was found in 72%, also an excess.

Neurological damage was known to have occurred in 19 of the 39 surviving infants. Fifteen of these 19 (79%) were associated with monochorionic placentation. The neurologically damaged twin infants, when compared to the normal infants, had the cotwin die later in gestation (31 vs 16.5 weeks), had a shorter duration between the death of the cotwin and delivery (2.5 vs 21 weeks), and delivered earlier in gestation (36.5 vs 39.5 weeks). The probable cause of neurological damage, in our opinion, was either exsanguination into the dead twin fetus, or disseminated intravascular coagulation which occurred in at least 13 cases. The incidence of antepartum death in a multiple gestation, and the potential for neurological damage is probably higher than previously thought. A review of the literature is presented and the clinical implications of this phenomenon are discussed.

Keywords

TwinsFetal DeathCNS damage
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 41 , Issue 1 , January 1992 , pp. 5 - 26
Copyright
Copyright © The International Society for Twin Studies 1992

References

REFERENCES

1.Anderson, RL, Golbus, MS, Curry, CJ, Callen, PW, Hastrup, WH (1990): Central nervous system damage and other anomalies in surviving fetus following second trimester antenatal death of cotwin. Report of four cases and literature review. Prenat Diagn 10:513–518.Google Scholar
2.Benirschke, K (1961): Twin placenta in perinatal mortality. NY State J Med 61:1499–1508.Google Scholar
3.Benirschke, K (1990): The placenta in twin gestation. Clin Obstet Gynecol 33:18–31.CrossRefGoogle ScholarPubMed
4.Benirschke, K, Kaufmann, P (1990): The Pathology of the Human Placenta. Springer-Verlag, New York.CrossRefGoogle Scholar
5.Bleker, OP, Breur, W, Huidekoper, BL (1979): A study of birth weight, placental weight and mortality of twins as compared to singletons. Br J Obstet Gynaecol 86:111–118.Google Scholar
6.Bulla, M, Lilien, Tv, Goecke, H, Roth, B, Ortmann, M, Heisig, J (1987): Renal and cerebral necrosis in survivor after in utero death of cotwin. Arch Gynecol 240:119–124.Google Scholar
7.Brenner, WE, Edelman, DA, Hendricks, CH (1976): A standard of fetal growth for the United States of America. Am J Obstet Gynecol 126:555–564.CrossRefGoogle ScholarPubMed
8.Cherouny, PH, Hoskins, IA, Johnson, TRB, Niebyl, JR (1989): Multiple pregnancy with late death of one fetus. Obstet Gynecol 74:318–320.Google ScholarPubMed
9.D'Alton, ME, Newton, ER, Cetrulo, CI (1984): Intrauterine fetal demise in a multiple gestation. Acta Genet Med Gemellol 33:43–49.Google Scholar
10.De Lia, JE, Cruikshank, DP, Keye, WR (1990): Fetoscopic neodymium: Yag laser occlusion of placental vessels in severe twin-twin transfusion syndrome Obstet Gynecol 75:1046–1053.Google Scholar
11.Donnenfeld, AE, Glazerman, LR, Cutillo, DM, Librizzi, RJ, Weiner, S (1989): Fetal exsanguina-tion following intrauterine angiographic assessment and selective termination of a hydrocephalic, monozygotic cotwin. Prenat Diagn 9:301–308.Google Scholar
12.Dudley, DKL, D'Alton, ME (1986): Single fetal death in twin gestation. Seminars Perinatol 10:65–72.Google ScholarPubMed
13.Durkin, MV, Kaveggia, EG, Pendleton, E, Neuhaeser, G, Opitz, JM (1976): Analysis of etiologic factors in cerebral palsy with severe mental retardation. I. Analysis of gestational, parturitional and neonatal data. Eur J Pediatr 123:67–81.CrossRefGoogle ScholarPubMed
14.Enbom, J (1985): Twin pregnancy with intrauterine death of one twin. Am J Obstet Gynecol 152:424–429.CrossRefGoogle ScholarPubMed
15.Fusi, L, McParland, P, Fisk, N, Nicolini, U, Wigglesworth, J (1991): Acute twin-twin transfusion: A possible mechanism for brain-damaged survivors after intrauterine death of a monochorionic twin. Obstet Gynecol 78:517–520.Google Scholar
16.Galea, P, Scott, JM, Goel, KM (1982): Feto-fetal transfusion syndrome. Arch Dis Childh 57:781–783.Google Scholar
17.Gonen, R, Heyman, E, Asztalos, E, Milligan, J (1990): The outcome of triplet gestations complicated by fetal death. Obstet Gynecol 75:175–178.Google ScholarPubMed
18.Hainline, SW, Nagey, DA (1982): Prospective obstetric management of a twin pregnancy complicated by death of one twin. NC Med J 43:708–709.Google Scholar
19.Hanna, J, Hill, J (1984): Single intrauterine fetal demise in multiple gestation. Obstet Gynecol 63:126–130.Google ScholarPubMed
20.Hoyme, HE, Higginbottom, MC, Jones, KL (1981): Vascular etiology of disruptive structural defects in monozygotic twins. Pediatrics 67:288–291.Google Scholar
21.Hughes, HE, Miskin, M (1986): Congenital microcephaly due to vascular disruption: in utero documentation. Pediatrics 78:85–87.Google Scholar
22.Johnson, SF, Driscoll, SG (1986): Twin placentation and its complications. Seminars Perinatol 10:9–13.Google ScholarPubMed
23.Jung, JH, Graham, JM, Schultz, N, Smith, D (1984): Congenital hydranencephaly/porencephaly due to vascular discruption in monozygotic twins. Pediatrics 73:467–469.CrossRefGoogle Scholar
24.Kindred, JE (1944): Twin pregnancies with one twin blighted: Reports of two cases with comparative study of cases in the literature. Am J Obstet Gynecol 48:642–682.CrossRefGoogle Scholar
25.Landy, HJ, Weiner, S, Corson, SL, Batzer, FR, Bolognese, RJ (1986): The “vanishing twin”: Ultrasonographic assessment of fetal disappearance in the first trimester. Am J Obstet Gynecol 155:14–19.CrossRefGoogle ScholarPubMed
26.Larroche, JC, Droule, P, Delezoide, AL, Narcy, F, Nessmann, C (1990): Brain damage in monozygous twins. Biol Neonate 57:261–278.CrossRefGoogle ScholarPubMed
27.Livnat, EJ, Burd, L, Cadkin, A, Keh, P, Ward, AB (1978): Fetus papyraceus in twin pregnancy. Obstet Gynecol 51 (suppl): 41s–45s.Google Scholar
28.Lumme, R, Saarikoski, S (1987): Antepartal fetal death of one twin. Int J Gynaecol Obstet 25:331–336.Google Scholar
29.Mannino, FL, Jones, KL, Benirschke, K (1977): Congenital skin defects and fetus papyraceus. J Pediatr 91:559–564.Google Scholar
30.Ottolenghi-Preti, GF (1972): Sopra un rarissimo caso di gravidanza gemellare con un feto papiraceo e con inserzione velamentosa del funicolo del feto vivo. Ann Ostet Ginecol 93:173–199.Google Scholar
31.Patten, RM, Mack, LA, Nyberg, DA, Filly, RA (1989): Twin embolization syndrome: Prenatal sonographic detection and significance. Radiology 173:685–689.Google Scholar
32.Posner, AC, Klein, MA (1954): Fetus papyraceus. Obstet Gynecol 3:106–110.Google Scholar
33.Potter, EL (1975): Pathology of the Fetus and the Infant, 3rd ed., Chicago: Year Book Medical Publishers.Google Scholar
34.Pritchard, JA, Ratnoff, OD (1955): Studies of fibrinogen and other hemostatic factors in women with intrauterine death and delayed delivery. Surg Gynecol Obstet 101:467–477.Google Scholar
35.Romero, R, Duffy, TD, Berkowitz, RL, Change, E, Hobbins, JC (1984): Prolongation of a preterm pregnancy complicated by death of a single twin in utero and disseminated intravascular coagulation. N Engl J Med 310:772–773.Google Scholar
36.Russell, EM (1961): Cerebral palsied twins. Arch Dis Childh 36:328–336.CrossRefGoogle ScholarPubMed
37.Saier, F, Burden, L, Cavanagh, D (1975): Fetus papyraceus: An unusual case with congenital anomaly of the surviving fetus. Obstet Gynecol 45:217–220.Google ScholarPubMed
38.Schinzel, AAGL, Smith, DW, Miller, JHR (1979): Monozygotic twinning and structural defects. J Pediatr 95:921–930.CrossRefGoogle ScholarPubMed
39.Shah, DM, Chaffin, D (1989): Perinatal outcome in very preterm births with twin-twin transfusion syndrome. Am J Obstet Gynecol 161:1111–1113.CrossRefGoogle ScholarPubMed
40.Skelly, H, Marivate, M, Norman, R, Kenoyer, G, Martin, R (1982): Consumptive coagulopathy following fetal death in a triplet pregnancy. Am J Obstet Gynecol 142:595–596.Google Scholar
41.Szymonowicz, W, Preston, H, Yu, VYH (1986): The surviving monozygotic twin. Arch Dis Childh 61:454–458.Google Scholar
42.Whitman, BK, Farquharson, DF, Baldwin, VJ, Wadsworth, LD (1986): The role of feticide in the management of severe twin transfusion syndrome. Am J Obstet Gynecol 155:1023–1026.Google Scholar
43.Yoshida, K, Matayoshi, K (1990): A study on prognosis of surviving cotwin. Acta Genet Med Gemellol 39:383–388.Google Scholar
44.Yoshida, K, Soma, H (1986): Outcome of the surviving cotwin of a fetus papyraceus or of a dead fetus. Acta Genet Med Gemellol 35:91–98.Google Scholar
45.Yoshioka, H, Kadomoto, Y, Mino, M, Morikawa, Y, Kasubuchi, Y, Kusunoki, T (1975): Multicystic encephalomalacia in liverborn twin with a stillborn macerated cotwin. J Pediatr 95:798–800.CrossRefGoogle Scholar