Sudden fetal death of a co-twin as a complication of intrafetal laser surgery and placenta examination with dye

Abstract

Monochorionic (MC) twin pregnancy is a distinct entity and has certain differences from dichorionic twins due to the unique placental angioarchitecture. It is characterized by twin-to-twin transfusion syndromes (twin oligohydramnios-polyhydramnios sequence and twin anemia-polycythemia sequence), acardiac twinning, selective fetal growth restriction and congenital anomalies. Selective termination is an option in MC twins complicated by selective fetal growth restriction and discordant fetal anomaly. Fetal demise of the co-twin can occur even after uncomplicated surgery. A selective fetal termination using an intrafetal laser was performed in the case of an MC twin pregnancy complicated by twin oligohydramnios-polyhydramnios sequence and hydro-cephalus in the donor twin. Fetal demise of the co-twin was observed after surgery. The placenta was examined with dye injections after abortion and showed vascular anastomoses causing unexpected fetal demise.