Outcome of twin pregnancies complicated by single intrauterine death in relation to vascular anatomy of the monochorionic placenta

The objective of this study was to determine the relationship between the t ype of placentation, vascular anatomy of the monochorionic (MC) placenta an d the perinatal outcome of the surviving twin following a single intrauteri ne fetal death (IUFD). In this retrospective study, 92 twin pregnancies com plicated by a single intrauterine death were identified from three tertiary referral centres [50 MC and 42 dichorionic (DC)]. Antenatal and neonatal d ata as well as information on the chorionicity, vascular anastomoses, and a utopsy findings were also obtained. The percentage risk of IUFD (26 versus 2.4; P < 0.001), anaemia (51.4 versus 0; P < 0.001) and intracranial lesion s at birth (46 versus 0; P < 0.001) was greater in MC than in DC twins. In MC twins without twin-twin transfusion syndrome (TTTS), perinatal mortality was higher in the group with superficial arterioarterial (AA)/venovenous ( VV) channels than those with only multiple bidirectional arteriovenous (AV) anastomoses (12/15 versus 0/8; P < 0.001), However, in the TTTS pregnancie s (n = 26), perinatal outcome of the surviving twin was dependent on whethe r the recipient (n = 16) or the donor twin (n = 10) died first. Incidence o f IUFD (9/16 versus 0/10; P < 0,001), severe anaemia (7/7 versus 1/10; P < 0.001) and intracranial lesions at birth (6/7 versus 2/10; P < 0.001) was c ommon in pregnancies where the recipient twin died first, In the TTTS group , unidirectional AV anastomotic channels were found in all but two placenta e, In conclusion, this study suggests that the outcome of twin pregnancies complicated by IUFD is dependent on the type of vascular anastomoses and TT TS.