Conservative Management of a Monochorionic Twin Pregnancy with an Intrauterine Fetal Death at 20-21 Weeks and Successful Term Delivery of the Second Twin.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Fadhilah Zulfa, Dian Tjahyadi, Raden Mas Sonny Sasotya, Adhi Pribadi, Dani Setiawan, Arnova Reswari, Luthfi Rahman
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Abstract

BACKGROUND One of the obstetric complications of twin pregnancy was the intrauterine death of one fetus. The death that occurs in the first trimester usually leads to fewer complications than the death in the second and third trimester. In the second and third trimesters, single fetal death of twin pregnancy was reported to increase the death, preterm birth, and neurological injury of the surviving co-twin. Although rare, it might trigger a coagulation defect in the mother as well. Neurological morbidities were also more common in monochorionic twins than in dichorionic gestation. Thus, a consideration of pregnancy termination might persist. CASE REPORT We present a case of a primigravida with a monochorionic twin pregnancy whose intrauterine death of one fetus at 20-21 weeks of gestation. We managed this patient with pregnancy continuation under close monitoring more than 12 weeks until she delivered the surviving one at term. The outcome of the surviving baby was normal condition and appropriate weight, no fetal morbidity, and no maternal morbidity related to coagulation disorder in the mother. CONCLUSIONS Conservative management under close monitoring until term in monochorionic twin pregnancy with single fetal death could be the best option to obtain a favorable outcome. We recommend conservative management with close surveillance monitoring using non-stress tests after 32 weeks, biweekly ultrasound, and at least of one maternal coagulation profile test.

保守治疗单绒毛膜双胎妊娠,20-21 周胎儿宫内死亡,第二胎成功足月分娩。
背景 双胎妊娠的产科并发症之一是一个胎儿在宫内死亡。发生在妊娠头三个月的胎儿死亡通常比发生在妊娠第二和第三个月的胎儿死亡导致的并发症要少。据报道,在第二和第三孕期,双胎妊娠的单胎死亡会增加存活的同卵双胎的死亡、早产和神经损伤。虽然这种情况很少见,但也可能引发母亲的凝血功能缺陷。神经系统疾病在单绒毛膜双胎中也比在双绒毛膜妊娠中更常见。因此,终止妊娠的可能性仍然存在。病例报告 我们报告了一例初产妇单绒毛膜双胎妊娠,其中一个胎儿在妊娠 20-21 周时死于宫内。我们对这名患者进行了持续妊娠管理,并对其进行了超过 12 周的严密监护,直到她足月分娩出存活的胎儿。存活胎儿的状况正常,体重适宜,没有胎儿疾病,也没有与母亲凝血功能障碍有关的产妇疾病。结论 对于单绒毛膜双胎妊娠合并单胎死亡的情况,在密切监护下保守治疗至足月是获得良好结局的最佳选择。我们建议在保守治疗的同时,在 32 周后使用非应激试验进行密切监测,每两周进行一次超声波检查,并至少进行一次母体凝血功能检查。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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