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Intrauterine single fetal death in twin pregnancies is known to be a serious complication of pregnancy. The rate of mortality and morbidity particularly increase in monochorionic twin pregnancies, and twin-to-twin transfusion syndrome, feto-fetal hemorrhage or discordant twin is complicated.
Recently, it is likely that perimortem feto-fetal blood transfusion through placental vessels which caused fetal anemia in a surviving fetus around the time of single intrauterine death have been considered to be a main mechanism leading for poor prognosis of the surviving fetus.
It is difficult to correctly predict anemic status in the surviving fetus. In fact, the anemia in the surviving fetus has been documented by a fetal blood sampling or a fetoscopic observation. However, recently reported that the ultra-sonographic findings like as middle cerebral artery peak systolic velocity (MCA-PSV) is reliable for predicting the severity of fetal anemia caused by exsanguinations of surviving co-twin in single fetal demise. The intrauterine rescue transfusion with LASER occlusion of anastomosis is a useful treatment to prompt recovery from severe anemia by feto-fetal transfusion resulted in a favorable outcome.
Therefore, it is suggested that fetal blood sampling and monitoring of MCA-PSV are useful markers to assess anemic status of the surviving fetus respectively. The intrauterine rescue transfusion and occlusive treatment of anastomosis can be a useful intervention to prevent the adverse outcome of surviving fetus in single fetal demise, after extensive counseling regarding the risks of these invasive procedures and possible outcome.