Conservative Management of a Monochorionic Twin Pregnancy with an Intrauterine Fetal Death at 20-21 Weeks and Successful Term Delivery of the Second Twin.

BACKGROUND One of the obstetric complications of twin pregnancy was the intrauterine death of one fetus. The death that occurs in the first trimester usually leads to fewer complications than the death in the second and third trimester. In the second and third trimesters, single fetal death of twin pregnancy was reported to increase the death, preterm birth, and neurological injury of the surviving co-twin. Although rare, it might trigger a coagulation defect in the mother as well. Neurological morbidities were also more common in monochorionic twins than in dichorionic gestation. Thus, a consideration of pregnancy termination might persist. CASE REPORT We present a case of a primigravida with a monochorionic twin pregnancy whose intrauterine death of one fetus at 20-21 weeks of gestation. We managed this patient with pregnancy continuation under close monitoring more than 12 weeks until she delivered the surviving one at term. The outcome of the surviving baby was normal condition and appropriate weight, no fetal morbidity, and no maternal morbidity related to coagulation disorder in the mother. CONCLUSIONS Conservative management under close monitoring until term in monochorionic twin pregnancy with single fetal death could be the best option to obtain a favorable outcome. We recommend conservative management with close surveillance monitoring using non-stress tests after 32 weeks, biweekly ultrasound, and at least of one maternal coagulation profile test.