Single foetal death in twin pregnancies: review of the maternal and neonatal outcomes and management.

OBJECTIVE To review the maternal and neonatal outcomes, and management of single foetal death in twin pregnancies. DATA SOURCES Medline literature search (1950 to 1999) and hospital audit of single antepartum foetal deaths in twin pregnancy from 1993 through 1997. DATA SELECTION Key words for literature search: twin pregnancy/pregnancies; single fetal death/demise. DATA EXTRACTION Data were extracted and reviewed independently by the authors. DATA SYNTHESIS During the study period, 182 (0.76%) of 23,804 deliveries involved twin pregnancies. Seven (3.8%) of the twin pregnancies were complicated by the death of one foetus. Single foetal death in a twin pregnancy in the late second and third trimesters is associated with significant morbidity and mortality in the surviving co-twin, especially in a pregnancy involving monochorionic twins. Management should be individualised; conservative management is preferred by most obstetricians. CONCLUSION Single foetal death in twin pregnancies should be managed in a tertiary referral centre, where intensive foetal surveillance and adequate neonatal support are available. A multidisciplinary approach should be adopted.