28 yrs female 2ng gravida with 24 weejs of twins baby ultrasound shows that the 2nd baby is IUFD and the 1st one is ok bt now the question is what can be the best management ?????
IUFD of one twin Prognosis • The prognosis for the surviving twin after demise of its co-twin is dependent on the cause of death, gestational age, degree of shared fetal circulation (chorionicity), and time interval between death of the first twin and delivery of the second. • Dizygous twin pregnancies do not share circulation . As such, death of one twin has little impact on the surviving twin. The dead twin may be resorbed completely or become compressed and incorporated into the membranes (fetus papyraceus). DIC in the mother is exceptionally rare. • Some degree of shared circulation can be demonstrated in 99% of monozygous twin pregnancies. In this setting, death of one fetus often results in immediate death of the other. If, by chance, the second fetus survives, it is at high risk of developing multicystic encephalomalacia. Management • Management of a surviving co-twin depends on chorionicity and gestational age. • Fetal wellbeing (kickcharts, non-stress testing, biophysical profile) should be assessed on a regular basis. In the setting of “fetal distress”/ non-reassuring fetal testing, immediate delivery is indicated. • Delivery should be considered once pulmonary maturity is docu- mented or a favorable gestational age is reached.
