Twin Gestation Single Demise & Co-Twin Surveillance Pathway

Placental Vascular Bed & Inter-Twin Hemodynamics Continuous AV / AA / VV Shunts Active

18% - 26%

Surviving Neuro Injury Risk

12% - 15%

Co-Twin Demise Risk

Day 28 - 42

Optimal Brain MRI Window

< 1.5%

Maternal Consumptive DIC Risk

Physiologic Mechanism: In monochorionic placentas, uncompensated vascular anastomoses allow acute reverse transfusion into the relaxed, low-resistance vascular bed of the demised twin at the moment of demise, causing sudden surviving co-twin hypotension, cerebral ischemia, and acute anemia.

Surviving Co-Twin Surveillance Protocol (SMFM) Post-Demise Day 7 Protocol

Maternal Coagulation Surveillance Trend Fibrinogen & D-Dimer

Holding Simultaneous Grief & Hope

Single twin demise creates a unique psychological reality of grieving one child while sustaining medical care and hope for the surviving co-twin. Immediate delivery is contraindicated solely for fetal demise unless independent obstetric indications arise.

Recommended: Specialized twin bereavement counseling, memory making, and perinatal palliative liaison.