Survival of Other Fetuses After a

Fetal Death in Twin

or Triplet Pregnancies

Rangga Patria Lazuardi

H2A011036
 Fetuses in multifetal gestation are more likely than
singletons to die in utero. When single fetal demise,
other fetus survival rate still jeopardy.

The vanishing twin syndrome, a term often used to

describe the death of one fetus of a multifetal
gestation during the first trimester of pregnancy.

Incidence of single fetal demise after the first

trimester among recognized multifetal gestations is
much lower,approximately 0.5 6.8%. It is often
difficult to determine the cause of a fetal demise;
however, cord entanglement, twin-twin transfusion
syndrome, abruptio placenta, chronic placental
insufficiency, and congenitalanomalies have been
reported as causes.
Materials and Methods
We limited our analyses to successfully linked twin
and triplet gestations in which all of the fetuses
survived to at least 20 weeks gestation (Figure 1).
After the exclusion of 5394 sets of twins and 525 sets
of triplets, there were 150,386 sets of twins (97%)
and 5240 sets of triplets (91%) available for analysis.

A total of 3599 (96%) of the 3735 sets of twins and

211 (95%) of the 222 sets of triplets met this
inclusion criterion and were retained for further
study.
 The gestational age at the time the first fetus
died was categorized as 2024 weeks, 2528
weeks, 2932 weeks, 3336 weeks, and 37
weeks or later. For triplets, we combined the last
two categories, as most of the triplets were
delivered before 37 weeks gestation.
Results
Discussion
Fetal deaths at 20 weeks gestation or more were
uncommon, 2.6% in twin pregnancies and 4.3%
in triplet pregnancies.

Among twins, remaining fetuses of same-sex

twin pairs were at higher risk of death compared
with those of opposite-sex twin pairs,
particularly when the initial fetal demise
occurred after 24 weeks gestation.
 This study has several deficiencies that should
be noted:
1. Impossible to pinpoint the exact time that a
fetal death has occurred, particularly in a
multifetal pregnancy.
2. Early fetal deaths, particularly those that
occurred at or before 24 weeks gestation,
may have been under-reported.
3. Limited to completely matched sets of twins
and triplets in which all of the fetuses
survived to at least 20 weeks gestation.
Conclusion
After a fetal death in a multifetal pregnancy at
20 weeks gestation or later, the survival of the
remaining fetuses is inversely related to the time
the death occurred. Among twins, survival also
depends on sex concordance, with opposite-sex
twins more likely than same-sex twins to
survive.
Thank you~