Introduction A monofœtal death is described in 0.5 to 7% of twin pregnancies. The neurological complications risk in the surviving twin is estimated at 18% in monochorionic pregnancies and it is based on vascular anastomoses between the fetal circulations.
Purpose To insist in twin pregnancy monitoring in case of one foetal death to avoid cerebral damage in the surviving twin.
Materials and Methods We report observations of 5 hospitalised newborns in Sfax Neonatology Department from August 2003 to October 2007 who presented neurological complications following foetal death of their twins.
Results The pregnancy was dichorionic in one case, monochorionic in the others. A twin transfusion syndrome was diagnosed in one case. The average term was 36 weeks and twin fetal death occurred at an average term of 33 weeks. The delivery was vaginal in two cases and caesarean in three. One child was clinically asymptomatic and the others showed neurological distress : convulsions or hypotonia. Transfontanellar ultrasound was done in one case, tomography in two cases, MRI in one case and Angio MRI in one case. Brain lesions were ischaemic in four cases and haemorrhagic in one. Death occurred in one case at the age of 10 days. There was a psychomotor retardation in the others with epilepsy in two cases.
Conclusion Cerebral damage in the surviving twin is based on different pathophysiological mechanisms. Strict monitoring should guide our choice of the appropriate moment of delivery.