Risk for surviving twin after fetal death of co-twin in twin-twin transfusion syndrome

Abstract Objective: To determine neonatal outcome of surviving twins in pregnancies complicated by twin–twin transfusion syndrome and fetal deaths of co-twins. Methods: We retrospectively reviewed medical records of 11 women seen during 1990–1996 in our hospital who had pregnancies complicated by twin–twin transfusion syndrome and death of one fetus. Results: The median interval between fetal death and delivery (six by cesarean delivery and five vaginally) was 2 weeks (range, 1 day to 7 weeks). Three of the 11 surviving twins died soon after birth (gestational ages at birth 32, 31, and 34 weeks; fetal death–delivery intervals 3, 7, and 7 weeks, respectively). Two survivors were severely handicapped (gestational ages at birth 29 and 33 weeks; fetal death–delivery interval 1 and 2 weeks, respectively). Two children showed cerebral echodensities on ultrasound after birth but developed normally, and four did not show any abnormalities on cerebral and abdominal ultrasound and developed normally. Five of 11 surviving twins, each born 1 week or more after fetal death of the co-twin, either died or experienced serious morbidity. In the two infants born within 1 day of fetal death, no problems were detected. Conclusion: In monochorionic twin gestations complicated by twin–twin transfusion syndrome, approximately half of surviving twins will experience mortality or serious morbidity when co-twins die in utero.