Perinatal Outcomes of Single Intrauterine Fetal Death in Twin Pregnancies: A Tertiary Center Experience

Year 2023, , 219 - 225, 30.04.2023

Müjde Can İbanoğlu , Betül Tokgöz , Kadriye Yakut Yücel , Seval Yılmaz Ergani , Erkan Saglam , Aykut Kından , Cantekin İskender , Ali Çağlar

https://doi.org/10.54005/geneltip.1236186

Abstract

ABSTRACT
Aim: Twin pregnancies are associated with increased perinatal mortality and morbidity compared with singleton pregnancies. Single intrauterine fetal death (sIUFD) is difficult to treat. This is because the twin who survives after sIUFD is at high risk for mortality, neurological damage, and other complications of preterm birth. Therefore, in this study, we aimed to determine the perinatal consequences for the surviving fetus. We also investigated the association between chorionicity, maternal characteristics, and fetal and maternal concomitant complications in these cases.
Methods: We conducted a retrospective case-control observational study that included twin births complicated by sIUFD followed up in the Department of Perinatology. Data, including demographic characteristics and prenatal invasive procedures, weeks of sIUFD, delivery time, fetal sex, interval between delivery and fetal loss, fetal distress, mode of delivery, birth weight, presence of placental pathology or umbilical cord abnormalities, neonatal Apgar scores in the first and fifth minutes, and need for neonatal intensive care unit (NICU), were obtained from obstetric records and hospital database.
Results: Fifty-three twin pregnancies with a single fetal death were included in the study. The mean age of the pregnants participating in the study was 30 (± 6) years. The mean body mass index (BMI) of the mother was 28.8 (22-43). Twenty-four (45.3%) cases were dichorionic (DC) diamniotic, 20 (37.7%) were monochorionic (MC) diamniotic, and 9 (17%) were monochorionic monoamniotic. The time between IUFD and birth of the live twin was 75 days in MCs and 105 days in DCs (p=0.150). The mean gestational age at birth of the surviving twin was 30 weeks’ gestation in MCs and 34 weeks’ gestation in DCs (p=0.030). In 23 (79.3%) MC pregnancies and 15 (62.5%) DC pregnancies, delivery occurred before 37 weeks (p=0.176). In addition, deliveries before 34 weeks occurred more frequently in 19 (65.5%) of MC pregnancies than in 8 (33.3%) of DC pregnancies (p=0.020).
Conclusion: We have shown that the birth of the live fetus in the MC group occurred at a significantly earlier time, and mortality and morbidity were observed more frequently in this fetus. However, this research explaining the etiology of sIUFD is insufficient.

Keywords

Single intrauterine fetal death, twins, perinatal outcomes, monochorionic, dichorionic.

Supporting Institution

none

Thanks

none

İkiz Gebeliklerde Tek İntrauterine Fetal Ölümün Perinatal Sonuçları: Üçüncül Merkez Deneyimi

Abstract

ÖZET
Amaç: İkiz gebelikler, tekil gebeliklere kıyasla artmış perinatal mortalite ve morbidite ile ilişkilidir. Tek intrauterin fetal ölüm (sIUFD)ise yönetilmesi zor bir durumdur. Çünkü SIUFD'den sonra hayatta kalan ikiz, mortalite, nörolojik hasar ve diğer erken doğum komplikasyonları açısından yüksek risk altındadır. Bu nedenle bu çalışmada hayatta kalan fetüsün perinatal sonuçlarını belirlemeyi amaçladık. Ayrıca bu olgularda koryonisite, maternal özellikler ve fetal ve maternal eşlik eden komplikasyonlar arasındaki ilişkiyi de inceledik.
Yöntemler: Perinatoloji Anabilim Dalı'nda izlenen sIUFD ile komplike ikiz doğumları içeren retrospektif bir vaka kontrollü gözlemsel çalışma yürüttük. Demografik özellikler ve prenatal invaziv prosedürler, intrauterine exitus gerçekleşitiği haftaları, doğum süresi, fetal cinsiyet, doğum ile fetal kayıp arasındaki süre, fetal distres, doğum şekli, doğum ağırlığı, plasenta patolojisi veya göbek kordonu anormallikleri varlığı, neonatal Apgar skorları dahil olmak üzere veriler birinci ve beşinci dakikalar ve yenidoğan yoğun bakım ünitesi (YYBÜ) ihtiyacı, obstetrik kayıtlardan ve hastane veri tabanından elde edildi.
Bulgular: Çalışmaya tek fetal ölümü olan 53 ikiz gebelik dahil edildi. Çalışmaya katılan hastaların yaş ortalaması 30 (± 6) idi. Ortalama vücut kitle indeksi (VKİ) 28,8 (22-43) idi. Yirmi dört (%45,3) vaka dikoryonik (DC) diamniyotik, 20 (%37,7) vaka monokoryonik (MC) diamniyotik ve 9 (%17) vaka monokoryonik monoamniyotik idi. IUFD ile canlı ikizin doğumu arasındaki süre MC'lerde 75 gün, DC'lerde 105 gündü (p > 0.05). Sağ kalan ikizin doğumdaki ortalama gebelik yaşı, MK'lerde 30 haftalık, DC'lerde 34 haftalık gebelik haftasıydı (p=0.03). 23 (%79,3) MC gebelikte ve 15 (%62,5) DC gebelikte doğum 37 haftadan önce gerçekleşti (p=0,176). Ek olarak, 34 haftadan önceki doğumlar, MC gebeliklerin 19'unda (%65,5), DC gebeliklerin 8'inden (%33,3) daha sık meydana geldi (p=0,02).
Sonuç: MC grubunda canlı fetüsün doğumunun anlamlı olarak daha erken gerçekleştiğini ve bu fetüste mortalite ve morbiditenin daha sık görüldüğünü gösterdik. Ancak SIUFD etiyolojisini açıklayan araştırmalar yetersizdir.

Keywords

Single intrauterine fetal death, twins, perinatal outcomes, monochorionic, dichorionic.

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