Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

IMPACT FACTOR 2018: 1.361
5-year IMPACT FACTOR: 1.578

CiteScore 2018: 1.29

SCImago Journal Rank (SJR) 2018: 0.522
Source Normalized Impact per Paper (SNIP) 2018: 0.602

See all formats and pricing
More options …
Volume 46, Issue 1


Clinical characteristics and outcome of twin pregnancies complicated by single intrauterine death

Qiong Luo
  • Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, China
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Xiujun Han
  • Corresponding author
  • Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, China
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-03-15 | DOI: https://doi.org/10.1515/jpm-2017-0008



To investigate the clinical characteristics and outcome of twin pregnancies complicated by single intrauterine death and how to improve the outcomes of surviving twins. Three thousand three hundred and eighty-four women who delivered twin pregnancies at Women’s Hospital, Zhejiang University, School of Medicine were included. Clinical and demographic data on gestational age, etiology, morbidity and mortality for mothers and fetuses were collected.


The median gestational age for detecting a single intrauterine death in twin pregnancy was 29 weeks and the average gestational age of pregnancy termination was 32 weeks. At least one complication occurred in 93 of 134 mothers (69.4%). The leading causes of a single intrauterine death were umbilical cord abnormality (21.6%), congenital anomalies (17.9%), twin-twin transfusion syndrome (TTTS) (8.2%) and velamentous placenta (7.4%). Of the 134 cases, in 115 cases the remaining twin survived. The birth weight of the surviving twin was significantly higher in pregnancies that continued for more than 1 week after single intrauterine death compared to that ended within 1 week after intrauterine death.


Extension of gestation for the surviving twin fetus as long as possible in ensuring the health of the surviving twin and mother, will improve the prognosis of surviving twin after a single intrauterine death.

Keywords: Clinical characteristics; complication; single intrauterine death; twin pregnancies; twin-twin transfusion syndrome (TTTS)


  • [1]

    Bajoria R, Kingdom J. The case for routine determination of chorionicity and zygosity in multiple pregnancy. Prenat Diagn. 1997;17:1207–25.CrossrefPubMedGoogle Scholar

  • [2]

    Barigye O, Pasquini L, Galea P, Chambers H, Chappell L, Fisk NM. High risk of unexpected late fetal death in monochorionic twins despite intensive ultrasound surveillance: a cohort study. PLoS Med. 2005;2:e172.CrossrefPubMedGoogle Scholar

  • [3]

    Fichera A, Zambolo C, Accorsi P, Martelli P, Ambrosi C, Frusca T. Perinatal outcome and neurological follow up of the cotwins in twin pregnancies complicated by single intrauterine death. Eur J Obstet Gynecol Reprod Biol. 2009;147:37–40.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [4]

    Johnson CD, Zhang J. Survival of other fetuses after a fetal death in twin or triplet pregnancies. Obstet Gynecol. 2002;99:698–703.PubMedGoogle Scholar

  • [5]

    Jelin E, Hirose S, Rand L, Curran P, Feldstein V, Guevara-Gallardo S, et al. Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Fetal Diagn Ther. 2010;27:138–41.CrossrefWeb of SciencePubMedGoogle Scholar

  • [6]

    Zhang R, Bo T, Shen L, Luo S, Li J. Effect of dexamethasone on intelligence and hearing in preterm infants: a meta-analysis. Neural Regen Res. 2014;9:637–45.Web of SciencePubMedCrossrefGoogle Scholar

  • [7]

    Hillman SC, Morris RK, Kilby MD. Single twin demise: consequence for survivors. Semin Fetal Neonatal Med. 2010;15:319–26.CrossrefWeb of SciencePubMedGoogle Scholar

  • [8]

    Evans MI, Lau TK. Making decisions when no good choices exist: delivery of the survivor after intrauterine death of the co-twin in monochorionic twin pregnancies. Fetal Diagn Ther. 2010;28:191–5.CrossrefWeb of SciencePubMedGoogle Scholar

  • [9]

    Bajoria R, Wee LY, Anwar S, Ward S. Outcome of twin pregnancies complicated by single intrauterine death in relation to vascular anatomy of the monochorionic placenta. Hum Reprod. 1999;14:2124–30.PubMedCrossrefGoogle Scholar

  • [10]

    Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynaecol. 2004;18:557–76.PubMedCrossrefGoogle Scholar

  • [11]

    Malone FD, D’Alton ME. Management of multiple gestations complicated by a single anomalous fetus. Curr Opin Obstet Gynecol. 1997;9:213–6.PubMedGoogle Scholar

  • [12]

    Malone FD, D’Alton ME. Anomalies peculiar to multiple gestations. Clin Perinatol. 2000;27:1033–46.PubMedCrossrefGoogle Scholar

  • [13]

    Joseph KS, Fahey J, Platt RW, Liston RM, Lee SK, Sauve R, et al. An outcome-based approach for the creation of fetal growth standards: do singletons and twins need separate standards? Am J Epidemiol. 2009;169:616–24.PubMedWeb of ScienceGoogle Scholar

  • [14]

    Senat MV. Intrauterine death and twin pregnancy. J Gynecol Obstet Biol Reprod (Paris). 2009;38:S100–3.PubMedGoogle Scholar

  • [15]

    Vayssière C, Benoist G, Blondel B, Deruelle P, Favre R, Gallot D, et al. Twin pregnancies: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2011;156:12–7.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [16]

    Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol. 1997;104:1203–7.CrossrefPubMedGoogle Scholar

  • [17]

    Grupo Colaborativo Neocosur. Very-low-birth-weight infant outcomes in 11 South American NICUs. J Perinatol. 2002;22:2–7.PubMedGoogle Scholar

  • [18]

    Hill LM, Chenevey P, Hecker J, Martin JG. Sonographic determination of first trimester twin chorionicity and amnionicity. J Clin Ultrasound. 1996;24:305–8.PubMedCrossrefGoogle Scholar

  • [19]

    Smith GC, Shah I, White IR, Pell JP, Dobbie R. Mode of delivery and the risk of delivery-related perinatal death among twins at term: a retrospective cohort study of 8073 births. Br J Obstet Gynaecol. 2005;112:1139–44.CrossrefGoogle Scholar

  • [20]

    Zorlu CG, Yalçin HR, Cağlar T, Gökmen O. Conservative management of twin pregnancies with one dead fetus: is it safe. Acta Obstet Gynecol Scand. 1997;76:128–30.CrossrefPubMedGoogle Scholar

About the article

Corresponding author: Xiujun Han, MD, Department of Obstetrics, Women’s Hospital, School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, China, Tel.: +86 571- 87061501, Fax: +86 571-87061878

Received: 2017-01-07

Accepted: 2017-02-09

Published Online: 2017-03-15

Published in Print: 2018-01-26

Author’s statement

Conflict of interest: Authors state no conflict of interest.

Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: National Natural Science Foundation of China (No. 81571447), and Major Science and Technology Projects in Zhejiang Province (2012C13024-2).

Citation Information: Journal of Perinatal Medicine, Volume 46, Issue 1, Pages 75–79, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2017-0008.

Export Citation

©2018 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Comments (0)

Please log in or register to comment.
Log in