INTRAUTERINE DEATH OF A MONOZYGOTIC TWIN - CARE OF THE SURVIVING TWINWITH MULTICYSTIC ENCEPHALOMALACIA AND PARENTAL COUNSELING

Intrauterine death of a monochorionic twin during the second or third trimester may expose the co-twin to the risk of severe brain damage. I nterventions such as selective feticide, endoscopic laser coagulation of placental vascular anastomoses, or early delivery have all been tri ed in situations where one twin is preagonal. As yet however, there is no convincing evidence that these interventions effectively prevent m ulticystic encephalomalacia in the surviving twin. In view of these fa cts, the authors believe that once the death of a monochorionic twin i s diagnosed, the pregnancy should be allowed to proceed for as long as possible and that elective preterm delivery should be avoided. The sp ecific issue of this communication is to focus on the multidisciplinar y approach which should follow once the intrauterine death of a monoch orionic twin has occurred. This paper discusses the peri- and postnata l role of the involved obstetrician, neonatologist and pediatrician co ncerning the complex medical management and parental counselling.