MONOFETAL DEATH IN MULTIPLE PREGNANCIES - RISKS FOR THE COTWIN, RISK-FACTORS AND OBSTETRICAL MANAGEMENT

The intrauterine death of one fetus in the case of multiple pregnancie s can have an impact on the development of the surviving twin. Based o n a single-centre retrospective personal study of 248 multiple pregnan cies, 10 of which presented a monofetal intrauterine death, the author s observed the type of placentation, the age and cause of the death, t he way in which pregnancy continued and the outcome of the surviving t win. This investigation also includes a review of published documents. Monochorial pregnancies were more frequently encountered in the case of monofetal death in utero. The etiology of the death was not always found and one surviving twin presented lesions as microcephaly convuls ions and was retarded on a psychomotor level. In this series these com plications did not exist when the pregnancy was bichorial. The authors conclude by demonstrating the major risk of fetal contamination for a live twin coexisting with a dead twin in the case on monochorial preg nancy. Other parameters (cause of death, gestational age at death, del ay and duration of cohabitation), do not seem to be significant. It wo uld appear to be of fundamental importance to establish an accurate di agnosis of placentation and to implement specific surveillance of mono chorial pregnancies. A decision tree is suggested for use in the case of monofetal death.