| Peer-Reviewed

Conservative Management of Single-twin Death at 22 Weeks’ Gestation at A Tertiary Hospital in North-central Nigeria: A Case Report and Review of Literature

Received: 18 July 2020     Accepted: 29 July 2020     Published: 20 August 2020
Views:       Downloads:
Abstract

Background: Single-twin intrauterine death in the second and third trimesters poses a great concern and psychological stress to both the parents and the obstetrician. A multidisciplinary approach to conservative management is associated with improved perinatal outcome for the surviving twin. Case: We present a 30-year-old gravida 2 para 1 (1 alive). She had an emergency caesarean section during her first delivery. Having been referred from a military hospital, she presented at 22 weeks with single-twin intrauterine death. She was admitted and discharged after one week. Subsequently, she was managed conservatively and had weekly antenatal follow-up visits. She kept a daily fetal kick chart, had fortnightly ultrasound scans for fetal growth and wellbeing and weekly maternal clotting profile. At 37 weeks of gestation, she had a successful repeat caesarean delivery of a live, male neonate with a birth weight of 3.9kg and Apgar scores of 9 at one minute and 10 at five minutes. The remains of the dead co-twin (fetus papyraceus) were seen attached to the placenta. Follow-up by the neonatologist showed that his developmental milestones were normal and comparable to those of his singleton peers. Conclusion: The management of single-twin intrauterine death after the second trimester is psychologically tasking, requiring adequate counselling for the couple. The multidisciplinary approach, adopted in this study, improved perinatal outcome for the surviving co-twin after 15 weeks of conservative management. Prolonged paediatric follow-up of the survivor was imperative.

Published in Journal of Gynecology and Obstetrics (Volume 8, Issue 4)
DOI 10.11648/j.jgo.20200804.18
Page(s) 113-116
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Single-twin Intrauterine Death, Conservative Management, Multidisciplinary Approach, Chorionicity, Maternal Coagulopathy, Fetus Papyraceus

References
[1] Kleinman JC, Fowler MG, Kessel SS. Comparison of infant mortality among twins and singletons: United States 1960 and 1983. Am J. Epidemiol. 1991; 133 (2): 133–143.
[2] National Institute for Health and Clinical Excellence. Multiple pregnancy: management of twin and triplet pregnancies in the antenatal period. NICE clinical guidance 129; September, 2011. London, England. National Institute for Health and Clinical Excellence, 2011.
[3] Ong S, Zamora J, Khan K, et al. Single Twin Demise: Consequences for the Survivor. In Baker P, Critchley H (eds). Multiply Pregnancy. RCOG Press, 2006; 149–165.
[4] Conte G, Righini A, Griffith PD, Rustico M, Lanna M, Mackie FL, et al. Brain-injured survivors of monochorionic twin pregnancies complicated by single intrauterine death: MR findings in a multicentre study. Radiology. 2018; 288 (2): 582–590.
[5] Kilby MD, Govind A, O’Brien PM. Outcome of twin pregnancies complicated by a single intrauterine death: a comparison with viable twin pregnancies. Obstet Gynecol. 1994; 84: 107–109.
[6] Tunc SY, Agacayak E, Goruk NY, Icen M, Findik FM, Evsen MS, et al. Single intrauterine demise in twin pregnancies; Analysis of 29 cases. Turk J Obstet Gynaecol. 2015; 12 (4): 226–229.
[7] Mark P. Umstad. Obstetric Management Update: Fetal death of a twin. Ages XXIX Annual Scientific Meeting 2019: Perfection, Professionalism and problems. O & G Magazine. 7th-9th March, 2019, Crown Towers, Perth (http://www.ogmagazine.org.au/linkout/8373).
[8] Jain D, Purohit RC. Review of twin pregnancies with single fetal death: Management, maternal and fetal outcome. J Obstet Gynaecol India. 2014; 64 (3): 180–183.
[9] Swarankar ML, Shekhawat V, Choudhary M, Choudhary V. Maternal and neonatal outcome of surviving twin after single fetal demise at 25 weeks. A rare case Report. Fertil Sci Res. 2017; 4: 30-34.
[10] Woo HH, Sin SY, Tang LC. Single foetal death in twin pregnancies: review of the maternal and neonatal outcomes and management. Hong Kong Med J. 2000; 6 (3): 293–300.
[11] Ong SSC, Zamora J, Khan KS, Kilby MD. Prognosis for the co-twin following single-twin death: a systematic review. BJOG 2006; 113: 992–998.
[12] Bajoria R, Kingdom J. The case for routine determination of chorionicity and zygosity in Multiple Pregnancy. Prenat Diag. 1997; 17: 1207–1225.
[13] Masheer S, Islam Z, Dileep D, Munim S. (2017). Twin chorionicity and prospective stillbirth risk: experience at a tertiary care hospital. Journal of the Pakistan Medical Association; 67 (3): 360–364.
[14] Romero R, Duffy TP, Berkowitz RL, Chang E, HobbinsJC. Prolongation of a Preterm Pregnancy complicated by death of a single twin in utero and disseminated intravascular coagulation. Effects of treatment with heparin. N Eng J Med. 1984; 310: 772–774.
[15] Babah OA, Olamijulo A, Ayanbode OS, Sanusi MM. Conservative management of a single fetal death in twin pregnancy at a tertiary health institution in southern Nigeria. A case Report. IOSR Journal of Dental and Medical Sciences. 2014; 13 (3): 79–83.
[16] Cattanach SA, Wedel M, White S, Young M. Single Intrauterine Fetal Death in a suspected monozygotic Twin pregnancy. Aust N Z J Obstet Gynaecol. 1990; 30: 137–140.
[17] Prompeler HJ, Madjar H, Klosa W, du Bois A, Zahradnik HP, Schillinger H, et al. Twin pregnancies with single fetal death. Acta Obstet Gynaecol Scand. 1994; 73: 205-208.
[18] Blickstein I, Perlman S. Single fetal death in twin gestations. J Perinat Med. 2013; 41: 65-69.
[19] Baweja KS, Pharmanand P. Continuation of pregnancy after abortion/delivery of first twin. J Obstet Gynaecol India. 2009; 59 (6): 573–575.
[20] Hillman SC, Morris RK, Kilby MD. Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet Gynaecol. 2011; 118: 928–940.
[21] Bajoria R, Wee LY, Anwar S, Ward S. Outcome of twin pregnancies complicated by single intrauterine death in relation to vascular anatomy of the monochorionic placenta. Hum Reprod. 1999; 14: 2124–2130.
[22] Landy HJ, Weingord AB. Management of multiple gestations complicated by an antepartum fetal demise. Obstet Gynecol Survey. 1989; 44: 171–176.
Cite This Article
  • APA Style

    Eka Po, Swende Tz, Ojabo Oa, Hembah-Hilekaan Sk, Ornguze Aa, et al. (2020). Conservative Management of Single-twin Death at 22 Weeks’ Gestation at A Tertiary Hospital in North-central Nigeria: A Case Report and Review of Literature. Journal of Gynecology and Obstetrics, 8(4), 113-116. https://doi.org/10.11648/j.jgo.20200804.18

    Copy | Download

    ACS Style

    Eka Po; Swende Tz; Ojabo Oa; Hembah-Hilekaan Sk; Ornguze Aa, et al. Conservative Management of Single-twin Death at 22 Weeks’ Gestation at A Tertiary Hospital in North-central Nigeria: A Case Report and Review of Literature. J. Gynecol. Obstet. 2020, 8(4), 113-116. doi: 10.11648/j.jgo.20200804.18

    Copy | Download

    AMA Style

    Eka Po, Swende Tz, Ojabo Oa, Hembah-Hilekaan Sk, Ornguze Aa, et al. Conservative Management of Single-twin Death at 22 Weeks’ Gestation at A Tertiary Hospital in North-central Nigeria: A Case Report and Review of Literature. J Gynecol Obstet. 2020;8(4):113-116. doi: 10.11648/j.jgo.20200804.18

    Copy | Download

  • @article{10.11648/j.jgo.20200804.18,
      author = {Eka Po and Swende Tz and Ojabo Oa and Hembah-Hilekaan Sk and Ornguze Aa and Dabit Oj and Maanongun Mt and Okoh Ea and Adia Jt},
      title = {Conservative Management of Single-twin Death at 22 Weeks’ Gestation at A Tertiary Hospital in North-central Nigeria: A Case Report and Review of Literature},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {8},
      number = {4},
      pages = {113-116},
      doi = {10.11648/j.jgo.20200804.18},
      url = {https://doi.org/10.11648/j.jgo.20200804.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20200804.18},
      abstract = {Background: Single-twin intrauterine death in the second and third trimesters poses a great concern and psychological stress to both the parents and the obstetrician. A multidisciplinary approach to conservative management is associated with improved perinatal outcome for the surviving twin. Case: We present a 30-year-old gravida 2 para 1 (1 alive). She had an emergency caesarean section during her first delivery. Having been referred from a military hospital, she presented at 22 weeks with single-twin intrauterine death. She was admitted and discharged after one week. Subsequently, she was managed conservatively and had weekly antenatal follow-up visits. She kept a daily fetal kick chart, had fortnightly ultrasound scans for fetal growth and wellbeing and weekly maternal clotting profile. At 37 weeks of gestation, she had a successful repeat caesarean delivery of a live, male neonate with a birth weight of 3.9kg and Apgar scores of 9 at one minute and 10 at five minutes. The remains of the dead co-twin (fetus papyraceus) were seen attached to the placenta. Follow-up by the neonatologist showed that his developmental milestones were normal and comparable to those of his singleton peers. Conclusion: The management of single-twin intrauterine death after the second trimester is psychologically tasking, requiring adequate counselling for the couple. The multidisciplinary approach, adopted in this study, improved perinatal outcome for the surviving co-twin after 15 weeks of conservative management. Prolonged paediatric follow-up of the survivor was imperative.},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Conservative Management of Single-twin Death at 22 Weeks’ Gestation at A Tertiary Hospital in North-central Nigeria: A Case Report and Review of Literature
    AU  - Eka Po
    AU  - Swende Tz
    AU  - Ojabo Oa
    AU  - Hembah-Hilekaan Sk
    AU  - Ornguze Aa
    AU  - Dabit Oj
    AU  - Maanongun Mt
    AU  - Okoh Ea
    AU  - Adia Jt
    Y1  - 2020/08/20
    PY  - 2020
    N1  - https://doi.org/10.11648/j.jgo.20200804.18
    DO  - 10.11648/j.jgo.20200804.18
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 113
    EP  - 116
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20200804.18
    AB  - Background: Single-twin intrauterine death in the second and third trimesters poses a great concern and psychological stress to both the parents and the obstetrician. A multidisciplinary approach to conservative management is associated with improved perinatal outcome for the surviving twin. Case: We present a 30-year-old gravida 2 para 1 (1 alive). She had an emergency caesarean section during her first delivery. Having been referred from a military hospital, she presented at 22 weeks with single-twin intrauterine death. She was admitted and discharged after one week. Subsequently, she was managed conservatively and had weekly antenatal follow-up visits. She kept a daily fetal kick chart, had fortnightly ultrasound scans for fetal growth and wellbeing and weekly maternal clotting profile. At 37 weeks of gestation, she had a successful repeat caesarean delivery of a live, male neonate with a birth weight of 3.9kg and Apgar scores of 9 at one minute and 10 at five minutes. The remains of the dead co-twin (fetus papyraceus) were seen attached to the placenta. Follow-up by the neonatologist showed that his developmental milestones were normal and comparable to those of his singleton peers. Conclusion: The management of single-twin intrauterine death after the second trimester is psychologically tasking, requiring adequate counselling for the couple. The multidisciplinary approach, adopted in this study, improved perinatal outcome for the surviving co-twin after 15 weeks of conservative management. Prolonged paediatric follow-up of the survivor was imperative.
    VL  - 8
    IS  - 4
    ER  - 

    Copy | Download

Author Information
  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Paediatrics, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Department of Obstetrics and Gynaecology, Benue State University Teaching Hospital, Makurdi, Nigeria

  • Sections