Conservative management of single fetal death in a twin pregnancy

Intrauterine death of a single fetus in a twin pregnancy during the second or third trimester is an uncommon complication and poses management challenge to the obstetrician. It also causes psychological stress and concern for the patient and her partner. We report a case of single fetal demise in a twin pregnancy, managed conservatively with a favourable outcome. A 31 years old lady, Para 1+1, referred from a cottage hospital, at a gestational age of 27 weeks, on account of demise of the leading twin, made on ultrasonography, following complaint of reduction in fetal movement of one-week duration. The patient was counselled and admitted to hospital for close monitoring. However, at 33 weeks gestation, six weeks following admission, she went into spontaneous labour and was subsequently delivered vaginally of a dead female leading twin (papyraceus) and a live female second twin. They weighed 300g and 2100g respectively, with a diamniotic-dichorionic placentation. Mother and baby were discharged home in stable state. The primary concern for single fetal demise in a twin pregnancy is its effect on the surviving fetus and mother. Regular antenatal care and routine ultrasonography in pregnancy are needed to make a diagnosis. Close monitoring of the wellbeing of the surviving twin and coagulation profile of the mother are crucial to manage possible complications.