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KMID : 0361719960070010042
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Korean Journal of perinatology
1996 Volume.7 No. 1 p.42 ~ p.47
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Twin Pregnancy Complicated by Single Fetal Death
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오정미
김은성/한호원/김문영/류현미/김의숙/최도영
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Abstract
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Although intrauterine fetal death of one twin in later pregnancy is unusual, it appears to be an increased risk in the mother and remaining fetus. We designed this study to assess the risk of surviving twin in twin pregnancy complicated by dead
fetus in
late pregnancy.
We studies 16 twin pregnancies with single fetus demise after 24 weeks that were delivered in our institution between January 1990 and December 1993. All maternal and newborn records were reviewed. We also followed clinical course of surviving
neonates
over one year period.
The incidence of single fetal demise in twin gestation was 3% in our study population. The type of chorionicity was determined in all 16 cases by sonographic findings before 12 weeks, by fetal sex and placenta pathology(Monochorionic 5 :
Dichorionic
11). The incidence of preterm delivery was similar in both placentation groups(Monochorionic 60% : Dichorionic 63%).
Monochorionic placentation group showed higher incidence of fetal growth retardation and perinatal mortality than dichorionic placentation group. And also surviving neonates in monochorionic placentation group has a 40% frequency of neurologic
sequelae.
On case of periventricular leukoencephalomalacia was diagnosed by perinatal ultrasound which was caused by possible twin embolization syndrome.
Although no over DIC was found, 3 cases of subclinical DIC was occurred with similar rate in both placentation groups(Monochorionic 20% : Dichorionic 18%).
After the second trimester, single fetal demise in twin gestation is associated with increased risk for the survivor or surviving fetus due to high incidence of growth retradation, preterm labor and perinatal mortality.
The fetal outcome showed that the prognosis for a surviving dichorionic twin is relatively good. By contrast the surviving monochorionic twin has a poor prognosis with a high frequency of neurologic damage.
Therefore, early diagnosis of chorionicity was emphasized in twin gestationand we have to close observation of surviving neonate for neurologi sequelae.
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KEYWORD
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