TWIN PREGNANCIES COMPLICATED BY THE DEATH OF ONE FETUS

The death of one fetus in a twin pregnancy can affect both the mother and the cotwin. Thirty women with twin pregnancies in whom the death o f one fetus was diagnosed during the second half of pregnancy and a ma tched group of 30 women with uncomplicated twin pregnancies were inves tigated. The mean gestational age at delivery for the study and contro l groups was 32.0 +/- 5.0 (mean +/- SD) weeks and 32.8 +/- 3.9, respec tively. Twelve pregnancies (40%) were monochorionic. In 15 (50%) the d iagnosis was made during active labor. The cesarean delivery rate was higher in the study group than in the control group (18 vs. 11, chi(2) = 5.43, P < .02). The mean neonatal weight was similar in both groups (1,586 +/- 725 g vs. 1,543 +/- 691 g). The subgroup of neonates (n = 15) whose cotwins were diagnosed as dead during labor had higher birth weight as compared to the neonates (n = 15) in whom the diagnosis was made prior to delivery and were managed expectantly (1,829 +/- 859 vs . 1,346 +/- 474 g, P < .01). The week of delivery was similar in both subgroups. Neonatal mortality was 30% and 26.6%, while neonatal morbid ity was 26.6% and 21.7%, respectively (NS). All the eases of neonatal mortality were in the subgroup of twins in which the diagnosis of in u tero death was made before 32 weeks' gestation. The death of one fetus from a twin pregnancy did Mot significantly jeopardize maternal healt h, and the neonatal outcome in the remaining twins was primarily a fun ction of gestational age. An expectant approach to these pregnancies s eems reasonable.