Monochorionic twins with one fetal death- a great concern but still a favourable outcome

It is a common observation that one twin is usually lost (vanished) in as many as 20 % of twin gestation diagnosed in first trimester. The early loss is reported to have negligible effect on the pregnancy. Second and third trimester loss is associated with significant morbidity and mortality in the survivor. There is 20% probability of neurological damage which is difficult to predict. The surviving twin should be evaluated with USG and/or MRI. If no lesions are observed, counselling and expectant management should be adopted. The outcome is worse in monochorionic than dichorionic pregnancies. A case report of 28 years old pregnant women with parity G0000was diagnosed with monochorionic twin gestation with one foetal death noted. Ultrasonogram revealed twin gestation with one foetal death with features of foetal Hydrops with Foetal Growth Restriction (FGR) in the live fetus. Close monitoring of the patient done with serial (biweekly) USG and weekly coagulation profile. She developed GHTN with GDM during her stay in hospital for which she received antihypertensive drugs and Metformin. She also received antenatally corticosteroids for foetal lung Maturity. Caesarean section was performed at 34 weeks of gestation, and normal new-born infant was discharged without any complications. We report a case of Monochorionic twins with one foetal death with complications mainlydue to vascular anastomosis and unequal placental sharing causing Twin Twin Transfusion Syndrome (TTTS) which mainly predispose to foetal growth restriction and the consequences of co-twin death.