Delivery after intrauterine death of one twin - query bank

Question: What is the mode of delivery of twin pregnancy when the leading twin is dead? Is there anything against vaginal delivery if there is not maternal or fetal compromise for the second non leading twin?

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Answer: Six small case series were identified, each including between 6 and 41 multiple pregnancies, mainly twins(1-6). The reported caesarean section rates varied between 16.7 and 93.3%

(Evidence level III)

The RCOG Study Group on Multiple Pregnancy (7) says that: "Vaginal delivery of the surviving co-twin is considered to be a reasonable option but, because of the high prevalence of vascular anastomosis in monochorionic twin placentas, many elect for caesarean delivery to avoid the potential risks of an acute TTTS" [twin-to-twin transfusion syndrome]

(Evidence level IV)


  1. D'Alton ME. Newton ER. Cetrulo CL. Intrauterine fetal demise in multiple gestation. Acta Geneticae Medicae et Gemellologiae. 33(1):43-9, 1984. Abstract 
  2. Jaw CS. Li YT. Hsu KP. Yeh KC. Tu FC. Tsui MS. [Twin pregnancy complicated by single intrauterine death. Report of six cases and literature review]. [Chinese] Chung Hua i Hsueh Tsa Chih - Chinese Medical Journal. 51(4):309-13, 1993 Apr. Abstract 
  3. Krayenbuhl M. Huch A. Zimmermann R. [Single intrauterine fetal death in twin pregnancy]. [German] Original Title - Singularer intrauteriner Fruchttod bei Gemini. Zeitschrift fur Geburtshilfe und Neonatologie. 202(2):60-3, 1998 Mar-Apr. Abstract 
  4. Liu S. Benirschke K. Scioscia AL. Mannino FL. Intrauterine death in multiple gestation. Acta Geneticae Medicae et Gemellologiae. 41(1):5-26, 1992. Abstract
  5. Lumme R. Saarikoski S. Antepartal fetal death of one twin. International Journal of Gynaecology & Obstetrics. 25(4):331-6, 1987 Aug. Abstract 
  6. Wilczynski J. Jaczewski B. Nowakowska D. Wysocki K. Szaflik K. Oszukowski P. Krasomski G. Czichos E. [Twin pregnancy complicated by intrauterine death of one twin]. [Polish] Original Title - Ciaza blizniacza powiklana obumarciem wewnatrzmacicznym jednego plodu. Ginekologia Polska. 71(11):1482-6, 2000 Nov. Abstract 
  7. Multiple pregnancy. Edited by M Kilby et al. RCOG Press: London, 2006. Consensus views available here

Search date: June 2011

Classification of evidence levels

Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.


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Date published: 16/06/2011

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