Consequences of in-utero death in a twin pregnancy.

Summary Background Twins have a higher mortality and morbidity than singletons and, among twins, the surviving co-twin of a fetus that dies in utero is particularly at risk. We did a cohort study to quantify mortality and serious morbidity in co-twin survivors of fetuses that died in utero. Methods We collected data of all registered twin births in England and Wales between 1993 and 1995 in which one twin was registered as having died in utero. Copies of all death certificates of these fetuses and death certificates of live-born co-twins of fetuses that died in utero were obtained from the Office for National Statistics. A questionnaire was sent to the general practitioners of all surviving co-twins to find out if the child had any disability. Findings There were 434 fetal death/live-birth same-sex twin pairs. Among the live births, there were 59 neonatal deaths, seven postneonatal deaths (first 28 days), and five infant deaths ( Interpretation The live-birth co-twin of a fetus that died in utero is at increased risk of cerebral impairment, the overall risk is 20% (95% Cl 16–25). The gestational-age-specific prevalence of cerebral palsy after fetal death of the co-twin is much higher than that reported for the general twin population.