Twin pregnancy complicated by single intrauterine death: problems and outcome with conservative management

Article Abstract:

It is not uncommon to have one twin die early in pregnancy while the other survives, without complications, through to delivery. However, when one twin dies later in pregnancy, during the second and third trimester (from 12 weeks to delivery), the health of the surviving fetus and the mother is compromised. There is a risk for disseminated intravascular coagulation (DIC), a condition in which clotting factors are produced in excess, followed by a lack of clotting factors and severe bleeding. Since a single twin death late in pregnancy is not common, appropriate management strategies are limited. The 11-year experience with 16 single twin deaths occurring late in pregnancy are reported. Eight of the 16 twins shared a fetal gestational sac (monochorionic), while the others had separate fetal membranes (dichorionic). None of the pregnancies were complicated by DIC. Prognosis was improved if the surviving twin was from a monochorionic rather than dichorionic pregnancy. Complications affecting surviving dichorionic twins are caused primarily by immaturity, whereas the surviving monochorionic twin generally suffers severe neurological damage such as spasticity and paralysis (complications not related to the delivery process or events that occurred during the early newborn period). Of the eight monochorionic twins, there were two deaths, three infants with neurological damage and three normal infants. There were six normal surviving dichorionic twins and two deaths that resulted from complications of immaturity or growth retardation. Survival does not appear to be improved by cesarean delivery. Fetal ultrasound, the use of high frequency sound to visualize internal structures, can be used to identify pregnancies complicated by twin-to-twin transfusion (shared blood vessels) and growth retardation, a condition that may benefit from early delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Twins

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Outcome of a second pregnancy after a previous elective caesarean section

Article Abstract:

The risk of maternal death associated with cesarean section is three times higher than associated with vaginal delivery. Although the death rate due to cesarean section is decreasing, the use of the procedure is increasing in England and Wales. Cesarean sections are performed more often on women in their first pregnancies, and are associated with complications of pregnancy or childbirth, such as delayed growth of the fetus or breech presentation (the abnormal positioning of the fetus with feet rather than head located closest to the birth canal). The effect of prior cesarean section on the outcome of future pregnancies is not known. The outcome of a second pregnancy following a previous cesarean section was assessed in 195 women who gave birth at a maternity hospital in London between 1980 and 1987. One hundred and fifty-four of these women successfully delivered vaginally in their second pregnancy. The chance of vaginal delivery was better among women who experienced spontaneous labor and among women giving birth to babies of normal birth weights. If these two criteria were met, and there were no other complications, a vaginal delivery after a previous delivery by caesarean section was possible for four out of five women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Wales, Childbirth, Delivery (Childbirth), Cesarean section, Natural childbirth, Great Britain

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