İkiz Gebeliklerde Tek İntrauterine Fetal Ölümün Perinatal Sonuçları: Üçüncül Merkez Deneyimi

Abstract

ABSTRACT Aim: Twin pregnancies are associated with increased perinatal mortality and morbidity compared with singleton pregnancies. Single intrauterine fetal death (sIUFD) is difficult to treat. This is because the twin who survives after sIUFD is at high risk for mortality, neurological damage, and other complications of preterm birth. Therefore, in this study, we aimed to determine the perinatal consequences for the surviving fetus. We also investigated the association between chorionicity, maternal characteristics, and fetal and maternal concomitant complications in these cases. Methods: We conducted a retrospective case-control observational study that included twin births complicated by sIUFD followed up in the Department of Perinatology. Data, including demographic characteristics and prenatal invasive procedures, weeks of sIUFD, delivery time, fetal sex, interval between delivery and fetal loss, fetal distress, mode of delivery, birth weight, presence of placental pathology or umbilical cord abnormalities, neonatal Apgar scores in the first and fifth minutes, and need for neonatal intensive care unit (NICU), were obtained from obstetric records and hospital database. Results: Fifty-three twin pregnancies with a single fetal death were included in the study. The mean age of the pregnants participating in the study was 30 (± 6) years. The mean body mass index (BMI) of the mother was 28.8 (22-43). Twenty-four (45.3%) cases were dichorionic (DC) diamniotic, 20 (37.7%) were monochorionic (MC) diamniotic, and 9 (17%) were monochorionic monoamniotic. The time between IUFD and birth of the live twin was 75 days in MCs and 105 days in DCs (p=0.150). The mean gestational age at birth of the surviving twin was 30 weeks’ gestation in MCs and 34 weeks’ gestation in DCs (p=0.030). In 23 (79.3%) MC pregnancies and 15 (62.5%) DC pregnancies, delivery occurred before 37 weeks (p=0.176). In addition, deliveries before 34 weeks occurred more frequently in 19 (65.5%) of MC pregnancies than in 8 (33.3%) of DC pregnancies (p=0.020). Conclusion: We have shown that the birth of the live fetus in the MC group occurred at a significantly earlier time, and mortality and morbidity were observed more frequently in this fetus. However, this research explaining the etiology of sIUFD is insufficient.