Conservative management of single fetal death in twin pregnancy at a tertiary health institution in southern Nigeria: a case report

Abstract

Introduction: The death of a twin in the second or third trimester of pregnancy is a rare obstetric complication. This might pose management challenge to the obstetrician. It is a cause of great concern and psychological stress to the parents. There are potential complications to the mother and the surviving twin. Despite the fact that Nigeria has one of the highest twinning rates in the world, very few case reports on twinning and its complications exist in the literature. Case: Presented is a 33 year old, unbooked, primigravid Nigerian woman who had intrauterine fetal death of the second twin at 32 weeks gestation. She was managed conservatively with close fetal surveillance and serial assessment of her clotting profile. She had successful induction of labour at 37 weeks with delivery of a live female baby whose birth weight was 2.45kg. The dead second twin (foetus papyraceous) was embedded within the placenta. Discussion: Few cases have been reported in other parts of the world. The mode of delivery in most cases being caesarean section. Our patient had successful vaginal delivery following induction of labour with no untoward effect to both mother and surviving twin. Conclusion: Vaginal delivery is safe following death of a twin and should be considered especially in Africa where there is aversion for caesarean delivery.