Intrauterine death of one fetus in monochorionic twinning is associated with high rates of perinatal morbidity and mortality in the surviving fetus. Subsequent development of
hydrops fetalis in the donor twin after
fetal demise of the recipient twin has been described in only two case reports and pathophysiology remains unclear. We report on a monochorionic-diamniotic twin pregnancy complicated by severe
twin-twin transfusion syndrome. Ultrasound examination at 20 weeks of gestation showed discrepant twins with
oligohydramnios in the smaller twins' sac and
polyhydramnios in that of the larger twin. Repeated amniocenteses permitted prolongation of the pregnancy. However, the recipient twin developed deteriorating
hydrops fetalis and died at 28 weeks of gestation. After this event, subsequent development of
hydrops fetalis in the surviving donor twin could be observed, as well as an increase of amniotic fluid. An elective
cesarean section was performed at 29 weeks of gestation. Initial
hypoxemia could be effectively treated by high frequency oscillatory ventilation,
surfactant therapy and inotropic support. The infant was discharged in good condition at the age of 2 months. Although rare, antenatal demise of the recipient twin in a monochorionic pregnancy can be associated with the subsequent development of
hydrops fetalis in the surviving donor twin. We speculate that this phenomenon is due to
ischemia-reperfusion injury of the previously poorly perfused twin.