The incidence, maternal, fetal and neonatal consequences of single
intrauterine fetal death in monochorionic twins: a prospective
observational UKOSS study
Objective: report maternal, fetal and neonatal complications associated
with single intrauterine fetal death (sIUFD) in monochorionic twin
pregnancies Design: prospective observational study Setting: UK
Population: 81 monochorionic twin pregnancies with sIUFD after 14 weeks
gestation, irrespective of cause Methods: UKOSS reporters submitted data
collection forms using data from hospital records. Main outcome
measures: aetiology of sIUFD; surviving co-twin outcomes: perinatal
mortality, central nervous system (CNS) imaging, gestation and mode of
delivery, neonatal outcomes; post-mortem findings; maternal outcomes.
Results: The commonest aetiology was twin-twin transfusion syndrome
(38/81, 47%), “spontaneous” sIUFD (22/81, 27%) was second commonest.
Death of the co-twin was common (10/70, 14%). Preterm birth
(<37 weeks gestation) was the commonest adverse outcome
(77%): half were spontaneous and half iatrogenic. Only 46/75 (61%)
cases had antenatal CNS imaging, of which 33 cases had known results of
which 7/33 (21%) had radiological findings suggestive of neurological
damage. Postnatal CNS imaging revealed an additional 7 babies with CNS
abnormalities, all born at <36 weeks, including all 4 babies
exhibiting abnormal CNS signs. Major maternal morbidity was relatively
common, with 6% requiring ITU admission, all related to infection.
Conclusions: Monochorionic twin pregnancies with single IUD are complex
and require specialist care. Further research is required regarding
optimal gestation at delivery of the surviving co-twin, preterm birth
prevention, and classifying the cause of death in twin pregnancies.
Awareness of the importance of CNS imaging, and follow-up, needs