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Early Second Trimester Twin-to-Twin Transfusion Syndrome in Monoamniotic Twin Pregnancy: The Cause and Management – A Case Report from Resource Limited Settings

Philippe PA, Cheruiyot A, Shurie S, Pallavi M and Orang'o OE

Monoamniotic twin pregnancies are the least common type of twin pregnancies, associated with high foetal death rates. In addition, twin-to-twin transfusion syndrome is a rare event in monoamniotic twins. The expectant management of early single-twin foetal demise is challenging due to risk to the surviving co-twin, and psychological impact on the mother. The authors report the case of early second trimester single-twin foetal demise, likely due to twin-to-twin transfusion syndrome in monochorionic twin pregnancy. The 22-year-old primigravida presented with vaginal bleeding in monoamniotic twin pregnancy. She then had sudden single-twin intrauterine demise at 16 weeks of gestation that ended with the delivery of viable growth restricted female neonate by caesarean section at 34 weeks.