Single Intrauterine Death in Twin Pregnancy: Evidenced-based Counselling and Management

The term cotwin with spatial pulmonary lesions and elevated maternal-neonatal D-dimer levels following single intrauterine fetal death in a monochorionic-monoamniotic twin pregnancy: a case report and literature review

BACKGROUND

Complications such as cerebral impairment, preterm delivery, and even intrauterine death can occur in monochorionic twin pregnancies with singleton fetal death. The coagulation functions of the surviving fetus and mother remain controversial.

CASE PRESENTATION

We reported a case of spontaneous single intrauterine fetal death at 17 weeks of gestation in a monochorionic monoamniotic twin pregnancy, followed by increased maternal and neonatal D-dimer levels and spatial pulmonary lesions in the surviving term cotwin, without cerebral impairment. The mother experienced significant postpartum pelvic hematoma, which was managed with conservative treatment and resolved.

CONCLUSIONS

Monitoring maternal and neonatal D-dimer, along with a detailed examination of the respiratory system and brain impairment of the surviving cotwin and newborn, maybe is crucial. This could be especially relevant in monochorionic monoamniotic twin pregnancies complicated by placental arterio-arterial or veno-venous anastomoses and elevated maternal D-dimer levels.

Preterm birth and stillbirth: total bile acid levels in intrahepatic cholestasis of pregnancy and outcomes of twin pregnancies: a retrospective cohort study from 2014 to 2022

BACKGROUND

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus and elevated serum bile acids. Twin pregnancies, as a type of high-risk pregnancy, present additional complexities when complicated by ICP compared to singleton pregnancies. Our study aims to investigate the relationship between bile acid levels in intrahepatic cholestasis of pregnancy and adverse pregnancy outcomes such as preterm birth and stillbirth in twin pregnancies.

METHODS

This retrospective single-center cohort study was conducted at the Second Hospital of Sichuan University from January 2014 to July 2022, focusing on twin pregnancies complicated by ICP. Patients were grouped based on peak levels of total bile acids during pregnancy. Differences among these groups in gestational weeks at delivery, preterm birth, fetal growth restriction, fetal distress, stillbirth, premature rupture of membranes, meconium-stained amniotic fluid, and newborn birth weight were observed as pregnancy outcome indicators.

RESULTS

In 1156 twin pregnancies complicated by ICP, were 430 cases classified as mild, 392 as moderate-low, 292 as moderate-high, and 42 as severe. Regarding pregnancy outcomes, significant differences were observed among the four groups of pregnant women in terms of gestational weeks at delivery (P < 0.001), rate of preterm birth (P < 0.001), newborn birth weight (P < 0.001), incidence of meconium-stained amniotic fluid (P < 0.001), and proportion of low birth weight infants (P < 0.001).

CONCLUSION

The study results indicate that the severity of intrahepatic cholestasis of pregnancy (ICP) is associated with adverse pregnancy outcomes such as preterm birth, newborn birth weight, and meconium-stained amniotic fluid contamination. Additionally, among different bile acid level groups, gestational weeks at delivery showed varying trends in stillbirth occurrence.

The Contribution of Multiple Pregnancies in Stillbirths in Greece: A Time-Trend Analysis

Introduction Multiple pregnancy is an established risk factor for fetal death. This study aimed to examine the impact of multifetal pregnancies on stillbirth rates (SBRs) in the Greek population. Methods Data on live births and stillbirths by multiplicity were derived from the Hellenic Statistical Authority, covering a 65-year period from 1957 to 2021. The SBR for multiple and single gestations, and the population attributable risk (%) (PAR (%)) stillbirth attributable to multifetal gestations were calculated, and temporal trends were assessed using joinpoint regression analysis, with annual percentage changes (APC) and 95% confidence interval (95% CI). Results In the period 1957-2021, multiple pregnancies accounted for 9.4% of total stillbirths in Greece and the overall relative risk of fetal death among multifetal gestations was 3.34, in comparison with singletons. The SBR in multiple births remained unchanged from 1957 to 1976 and showed downward trends from 1976 to 2021 (APC = -3.0, 95% CI: -3.4 to -2.7, p < 0.001). PAR (%), after two decades of stability, showed an increasing trend over the period 1975-2011 (APC = 3.4, 95% CI: 2.8 to 4.0, p < 0.001), which was reversed in the more recent decade 2011-2021 (APC = -6.1, 95% CI: -9.6 to -2.5, p = 0.001), with PAR (%) decreasing from a historical high of 19.3% in 2012 to 8.6% in 2021. Conclusion The high incidence of multiple births has a considerable impact on stillbirth rates in the Greek population. The recent downward trends of SBR and PAR (%) of multiple gestations are encouraging, however more measures and targeted interventions are needed to improve perinatal outcomes in multifetal gestation.